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App key number: ___ ENERGY ASSISTANCE PROGRAM UTILITY AFFIDAVIT Complete ONLY if your Utility Bills are in the name of someone who does not reside in the household Head of Households Name:Date:Address:City/State/Zip:Utility
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Gather all necessary information such as name, address, account number, and contact information.
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Who needs utility affidavit complete only?

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Individuals who are required to prove their utility usage or residency for a specific purpose, such as applying for government assistance or legal matters.
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Utility affidavit complete only is a legal document that certifies that all utility bills and payments are up to date and that there are no outstanding balances on any utilities.
Anyone who is responsible for the payment of utilities at a certain property may be required to file a utility affidavit complete only.
To fill out a utility affidavit complete only, the individual must provide their name, address, account numbers for each utility, and sign the document certifying that all utility bills are paid in full.
The purpose of a utility affidavit complete only is to ensure that all utility bills and payments are up to date, and that there are no outstanding balances on any utilities.
The information that must be reported on a utility affidavit complete only includes the individual's name, address, account numbers for each utility, and a certification that all utility bills are paid in full.
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