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Income-Qualified Assistance Program (IQAP) Renewal 2019

(To be completed by Fort Collins Utilities account holder)
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*You must notify Utilities Customer Service of address change to remain on this program.
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Affidavit of eligibility. My signature below certifies all information on this renewal application is true and accurate and in accordance with LEAP eligibility, that I am lawfully present in the United States, the total household income for this residence is less than the program household size adjusted income ceiling, and the applicant named above lives at this address full time, I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal law of Colorado as perjury in the second degree under C.R.S. 18-8-503, and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.
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