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Trash & Recycling Senior Citizen Discount Form

  1. Senior Discount Form

    Please Complete this form in its entirety.

  2. I am a resident of Muhlenberg Township and live at the listed address. I understand that by signing this statement, I am indicating that I wish to take advantage of the senior citizen discount rate for Muhlenberg Township trash and recycling services. I certify that I am eligible for this discounted rate because:

    Please choose one option.

  3. Note: False statements, including age, address, and occupancy of household may result in the revocation of the senior discount and the Township will be entitled to a refund of all discounts, penalty charges and other remedies provided by law.

    I declare under penalty of perjury of law and pursuant to 28 U.S.C. Section 1746 that the foregoing is true and correct statement to the best of my knowledge.

  4. For Office Use Only

  5. Form of Identification Provided

  6. Please upload a photo or scan or your identification.

  7. Leave This Blank:

  8. This field is not part of the form submission.