CMP Income Verification Form for Low Income Energy Management Program

I understand that Central Maine Power Company will offer me free Energy Management Programs if I meet the guidelines below and heat my home with electricity or have an electric water heater. 

I certify that the total income for all members of this household does not exceed the following guidelines*:

Members in Household	Maximum Household  Income Limit**
1	$14,355
2	$19,245
3	$24,135
4	$29,025
5	$33,915
6	$38,805
7	$43,695
8	$48,585
More than 8 members	Add $4,890 for each additional member
______	$_____________

* Guidelines are based on last year's income tax return(s) (1040, 1040EZ, or 1040A) for all members of the household, or current levels of income if that income has changed in the last three months.

** Maximum household income is determined by 2000 Tax Return(s)

Line #14 on Form 1040A

Line #04 on Form 1040EZ

Line #22 on Form 1040