IF YOU ARE REQUESTING NON-FOOD EMERGENCY ASSISTANCE PLEASE HAVE THE FOLLOWING INFORMATION Date: -2025 NAME: Address: Email address: PHONE NUMBER: REQUEST: Propane company - Phone number - Account number - Partial fill: /MINIMUM FILL: Please ask your propane company what a minimum fill would cost. Able to pay towards amount? Status (Empty/Shut off/other) Amount in tank: Balance due? Fuel oil company - Electric company - Name(s) on account: Amt due: Prior balance: Current: Shut-off/Reconnect: Due date: Phone number - Account number - Natural gas company - EMAIL: CASEWORKER/Case #: DHHS recent assists: Other agencies contacted: Ie: