2000 South Central Ave, Marshfield, WI 54449

Phone: (715) 387-1195 Staff/Commissioner: Login

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MARSHFIELD UTILITIES

INCOME VERIFICATION FORM

The information requested below is used to evaluate if your household is exempt from posting a required deposit.

INSTRUCTIONS:

  • Column A Print the full name of each person living in the household.
  • Column B Print the age of each person living in the household.
  • Column C Total gross income from wages for each person living in the houshold per month.
  • Column D Total gross income from support for each person living in the houshold per month.
  • Column E Total gross income from any other source for each person living in the houshold per month.

Fields with (*) are required.

A. *Name

B. *Age

C. *Income: Wages

$
$
$
$
$
$

D. *Income: Support

$
$
$
$
$
$

E. *Income: Other

$
$
$
$
$
$


Customers not wishing to complete the online application, may print the PDF version and fax, email, mail or bring to Marshfield Utilities office. Please remember processing will be delayed. Marshfield Utilities must have one business day to process a completed application, but only after it is received.

Download PDF Version