City of Chico Finance Office P.O. Box 3420 Chico, CA 95927 (530) 879-7320 Utility User’s Tax Refund Application Exemption Program Application           UTILITY USER’S TAX APPLICATION AND CLAIM EXEMPTION PROGRAM Name: Phone: Age: Service Address: Household Size: Mailing Address:    Annual Household Income: $ Source: This application for refund must be supported with proof of household income along with copies of utility bills for the period of May 1, 2018 through April 30, 2019 and proof of payment by claimant or member of household. After this application has been audited by the Finance Office, a refund will be issued in accordance with refund provisions on the back of the application. Utility Users’ Tax Paid Month/Year Gas & Electric Service Water Service May 2018 June 2018 July 2018 August 2018 September 2018 October 2018 November 2018 December 2018 January 2019 February 2019 March 2019 April 2019 TOTAL $ $ $ 0.00 $ CLAIMED REFUND TOTAL Telephone Service $ 0.00 $ 0.00 $ 0.00 1. I certify that I have read this application and the General Information (on reverse side) thoroughly, that I understand its content, and that I have supplied true and correct information herein to the best of my knowledge and belief. 2. I understand that any person required to sign and verify any report under the provisions of the City of Chico Municipal Code, who makes any false or fraudulent request with intent to defeat or evade the determination of any amount, is guilty of a misdemeanor. DO YOU WANT YOUR UTILITY BILLS RETURNED? YES NO (CIRCLE ONE) IF NOT INDICATED, BILLS WILL NOT BE RETURNED Applicant Signature: Date: City of Chico Finance Office P.O. Box 3420 Chico, CA 95927 (530) 879-7320 Utility User’s Tax Refund Application Exemption Program Application A refund or an exemption from City Utility Users’ Tax, for utility services provided may be approved when the following conditions are met: (1) (2) (3) (4) The applicant shall be the person in whose name the bills for utility services were rendered. City of Chico resident files an application with the City of Chico Finance Office for a refund or an exemption. The application is approved by the Finance Office as being in conformance with Section 3.56.190 and/or 3.56.200 of the Chico Municipal Code. Only one member of each household may file an application and only one application may be filed for each household. The combined annual income of the household in which the applicant lives for the 2018 Federal and State Personal Income Tax Year was less than the maximum annual income limits in the following schedule: Household Size 1 2 3 4 5 6 7 8 Maximum Annual Income $37,250 $42,600 $47,900 $53,200 $57,500 $61,750 $66,000 $70,250 Maximum Refund $119 $136 $153 $170 $184 $198 $211 $225 Applications for Utility Users’ Tax paid will be accepted from May 1, 2019 to June 30, 2019 for tax paid between May 1, 2018 and April 30, 2019. The application must be accompanied by:  Proof of household income (2018 Tax Return, Disability Statement, Social Security Letter, etc.)  Copies of the utility bills including paid by the applicant. Refunds will be processed as follows:  No refund shall be made on any application filed or postmarked later than June 30, 2019.  All applications for refund will be paid with a check from the City of Chico.  The City of Chico may take up to six weeks to issue a refund check. Applicants for the Exemption Program shall have attained the age of 60 years prior to making the application for exemption. Eligibility for tax exemption for applicants 60 years or older shall be based on the maximum income for a two-person household as set forth above ($42,600 for 2018). Applications for exemption are accepted any time during the year and must be accompanied by:  Proof of household income (2018 Tax Return, Disability Statement, Social Security Letter, etc)  Age of the applicant as documented by driver’s license or birth certificate.