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Statement of COVID-19 Vulnerable Status

  1. Statement of Understanding*

    The Governor of the State of Montana issued Executive Orders 2-2020 and 3-2020 declaring that a state of emergency exists in Montana due to the global outbreak of COVID-19 Novel Coronavirus. On March 30 and April 13 Directives were issued providing measures to limit foreclosures, evictions, and disconnections from [utility] services during the State of Emergency. On May 19, 2020 a Directive implementing Executive Orders 2-2020 and 3-2020 and establishing conditions for Phase Two reopening of businesses and operations were released. In part this Directive allowed for the terms of the March 30 and April 13 Directives and all of their terms to remain in effect through May 24, unless modified by subsequent Directive, except as follows: o For individuals who are members of a vulnerable population, who have suffered a significant financial hardship as a result of the outbreak, and who, pursuant to this Directive, remain sheltered at home, the protections of the March 30 and April 13 Directives continue and will expire 30 days after the individual ceases to shelter at home or at the end of the emergency, whichever is sooner. o An individual who seeks the protection of these provisions to prevent a foreclosure, eviction, or disconnection after June 1 must make a basic showing to their bank, landlord, or utility that they are (1) sheltering in place under this order, are (2) a member of a vulnerable population, and (3) have been financially impacted as a result of the COVID-19 outbreak. Members of the ‘Vulnerable Population’ are defined as “People over 65 years of age, people with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, or asthma, and people whose immune system is compromised such as by chemotherapy for cancer or other conditions requiring such therapy.” I HAVE READ THE ABOVE STATEMENT AND UNDERSTAND THE INFORMATION PROVIDED.

  2. Statement of Vulnerable Status*

    I hereby certify the following to be true and that I am eligible to receive a continuing exemption for late fees and shut-off of my utility services:

  3. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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