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City of Emporia

201 South Main Street, Emporia, VA, 23847, US

Form Section 1

Contract for Utility Services

201 South Main Street
Emporia, Virginia 23847

Date Picker
Date Picker
Full Name

“The information regarding race, ethnicity, and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Utilities Service that the Federal laws prohibiting discrimination against applications on the basis of race, color, national origin, religion, sex, familial status, age, and disability are complied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity, and sex of individual applicants on the basis of visual observation or surname.”

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