This CARES Act assistance application:
Will provide partial assistance for bills dated March 1, 2020, to November 01, 2021, and may not be used for past due amounts prior to this time period.
May only be used to pay water and sewer consumption and base charges. It will not be applied to deposits or late charges. These amounts are still due.
I desire to receive any assistance to which I am legally entitled under this program and its specifications.
I certify that the reason I am eligible for this CARES Act assistance is correct to the best of my knowledge and belief.
I understand that my signature on this form gives permission for the Fauquier County Water and
Sanitation Authority to verify records as necessary to verify my eligibility for assistance.
I understand that if I give false information or withhold information in order to make myself eligible for
benefits that I am not entitled to or apply for assistance at more than one site, I can be prosecuted for
fraud and/or denied assistance in the future.
I understand that the agencies involved in this program may verify all of the information which I have