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The information requested by the Federal Government in order to monitor compliance with the Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish, we are required to note the race/ national origin of individual applicants on the basis of visual observation or surname.
PLEASE SIGN AND SUBMIT APPLICATION
In order to obtain service with the Jackson County Water Utility all Rental applicants will need sign, date and submit this form.