Hardship Extension Request
Name: ________________________________________________________________________
Accounts Requested for Hardship: _________________________________________________
Explanation of Need and/or Hardship:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Contact Number: _______________________________________________________________
Contact Email: __________________________________________________________________
Please note the City desires to assist citizens in this tough time, however, requesting the
Hardship Extension does not guarantee that it will be accepted. Any request submitted will be
responded to by Utility Billing Staff regardless if it is accepted or denied. Please email the form
to Kathy.Cotton@groveland-fl.gov, submit at City Hall through the drop box, or if open to a
Utility Staff member.
________________________________ __________________________ ____________
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