Complete the below form or click HERE to download and print the form. Once completed, send, fax, or deliver to City Hall.


In order to qualify for the Low Income Discount (applies to service charge only) for City utilities, you must meet all of the following criteria:

  1. Must be owner or occupant (renter) at the service address where you receive a utility bill from the City in your name;
  2. Must not live in a house or an apartment which is part of a Federally-subsidized House program where rent/utilities are supported by the Government;
  3. Must reside at the address where City utilities are provided on a permanent basis as opposed to a seasonal, part-time or vacation basis.  To qualify as a permanent resident, you must reside at the service address for a minimum of 180 days per year and receive mail locally all year; and
  4. Discount applies as follows: (Income levels will be adjusted annual according to the United State Dept of Heath & Human Services Poverty Guidelines)

Total Household Income   Discount
$21,331 - $24,812 5%
$13,225 - $21,330 10%
$7,972 - $13,225 25%
$7,971 and under 40%


Maximum total discount allowed per household per year is $300.00

IMPORTANT: If you meet all of the criteria above, please complete the form below, carefully read and acknowledge the Terms and Conditions statement, and then submit the form. You will be contacted by City Hall in a few days.


I hereby certify under the penalties of either civil or criminal perjury that I have read, understood, and meet all of the above criteria.  I further understand that if at any future date I no longer meet the criteria, it is my obligation to advise the City.  Failure to do so could result in back billing to the date of ineligibility by the City.  I consent and agree that the City of South Bend may verify and confirm the above if deemed necessary.  The Social Security Administration and Internal Revenue Service are authorized to release income and retirement information as necessary for the City to determine my eligibility for a Low Income Discount for City utilities.