Utility Assistance Inquiry

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Completing this form does not guarantee financial support.

* Indicates required question

First & Last Name

Phone

Are you currently employed? *

Yes

Are you an Otsego County resident? *

Yes

Are you the account holder on your utility request? *

Yes

Utility assistance needed

Electric

Propane

Both

Other

If other, what is your primary source of heat?

Do you have a shut off notice?

Yes

What percent (%) is your propane at currently?

If yes, how many months and total amount is past due?

Do you have an eviction notice? *

Yes

Have you received any utility assistance since October 1st, 2023? *

Yes

If yes, what assistance did you receive and from what organization?

Have you applied with Department of Health and Human Services (DHHS) for a State of Emergency Relief (SER) *

Yes

If yes, do you have a determination of assistance?

Yes

How many individuals are in your household? (Children and adults)

Your inquiry was submitted.

116 E 5th St, Gaylord, MI 49735

Hours | Mon - Fri, 9am - 4pm

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