Lakeside Oregon Copyright © 2011 Privacy and Terms of Use Policy

Lakeside
Oregon
Sewer
Assistance
Program

Assessment Form Instructions

 

This program was created to help those who financially require help from our community.

 

Please download and complete the following application form, sign and date it, and then call the Coordinator to set up an appointment.  A member of the Assessment Committee will meet with you to verify the information you provide.  You will need to provide the following:

 

1. Verification of both income and expenses. For income, this will be your most recent paystub and/or bank statement showing direct deposit of wages, social security income, etc.  For expenses, we will need your most recent rent or mortgage receipts and utility bills, etc.

2. Two forms of identification, one of which must be a photo ID.  These may include your DMV ID card, or Oregon Driver’s License, your social security card, military ID, and/or a medical insurance card.

3. Bring your most recent Federal and State Tax returns.

 

You will be notified at a later time whether or not your application has been accepted.

 

 

THANK YOU FOR APPLYING FOR THIS PROGRAM!


IF YOU ARE A SHUT-IN, SPECIAL ARRANGEMENTS CAN BE MADE TO COME TO YOUR HOME FOR YOUR ASSESSMENT MEETING.

 

 

 

PLEASE CLICK THIS LINK TO DOWNLOAD THE APPLICATION FORM.

 

 

 

PLEASE NOTE:  IT IS NECESSARY TO RE-APPLY FOR THIS PROGRAM EVERY SIX MONTHS.

Darline Atkin, Coordinator (541-759-2356)