Paint a Thon of Dundee Township

Transcription

1 Paint a Thon of Dundee Township Dear Paint-A-Thon Applicant, Every year, the Paint a Thon of Dundee Township organizes a volunteer effort to paint homes in our community. The purpose of this program is to provide maintenance assistance to residents of the Township that do not have the resources to do so. Painting the exterior of a home can add value in both appearance and overall durability. The annual Paint-A-Thon of Dundee Township will take place on Saturday, September 12, The rain date for this event is scheduled for Saturday, September 19, The Paint-A-Thon application process is open to all residents of the Township that are 65 years and older, veterans or disabled. Due to limited resources, successful applicants will be chosen based on their assessment of need. Applicants who demonstrate a greater need for the benefits offered through the program will be scored higher. All applications should be turned in by July 1, 2015 at 5PM. Late applications will not be accepted. Please Ken at kpozehl@att.net with any questions related to the application process or call

2 2015 Paint a Thon ofdundee Township Homeowner Application Please print- Incomplete applications will not be accepted Name(s) ofhomeowner(s): Street Address: date of birth: dmeofbmh: Home Phone# Cell Phone# Other persons living in the home and their ages: list relationship to homeowners. Are you a current member of the US military? If you answered yes to last question, please list branch of service and dates of service. Are you or a member of your household disabled? If yes please explain.

3 Report of Income Include the annual income of each member in your household that is over 18 years old. Use extra pages if necessary. Name annual SSI disability public all other total wages income assistance income ' J, ~--' I i ' I!-----+[ J : Total household income $ ASSETS: Please fill in the correct amounts or write in "none" as it applies. Savings: ( Checking: Certificates ofdeposit: ' Stocks I Bonds:'""'"' List any other properties or buildings you own in addition to the home you occupy.

4 Please be aware that you are required to provide sufficient evidence of your income and lor assets. Additionally, selection of participants is competitive and the Paint a Thon of Dundee Township retains the right to reject any or all application requests. I(we) do not plan to sell our home in the next three(3) years: Yes No If we sell our home in the next 3years we will reimburse The Paint a Thon of Dundee Township. The cost of the materials used to paint our home. Homeowners signature: CONDITIONS, CONSENTS, AND RELEASE STATEMENTS: I do hereby voluntarily request, authorize and grant permission to the Paint a Thon of Dundee Township, it's agents, employees, and volunteers to take such actions as are necessary and deemed appropriate by the Paint a Thon committee to paint the exterior of my home and /or garage located on the property. I acknowledge and accept that the Paint a Thon of Dundee Township is not representing that the proposed preparation and painting of my residence and/or garage will be preformed by professionals and as such, the work could result in certain flaws. I accept that all actions taken by the Paint a Thon of Dundee Township to paint the exterior surfaces of my residence and /or garage will performed responsibly. In consideration of the Paint a Thon's committee actions in painting my home and/or garage, I do hereby release and forever discharge the Paint a Thon of Dundee Township, it's officers, agents, employees and volunteers from any and all causes of action, claims, demands, damages, costs, injuries to person or property, loss of service, expenses and compensation which may hereafter arise on behalf of myself, my heirs, executers, assignees and personal representatives arising out of the Paint a Thon committees actions in painting my home and/or garage. Ifl am selected to participate in this project, I agree to: *Complete all preparatory items( e.g. moving items away from your house, relocating lawn furniture, etc.) that will be ID" by the project coordinator and/or his/her designee not less that 10 days prior to paint day. *Allow a volunteer(s) to prepare the surfaces of my house and/or garage for paint prior to paint day. *Be present at my property on the day of the painting. * Allow pictures at my property to be taken for publicity purposes; *Make my RESTROOM facilities readily available to volunteers: * Have a family member or friend there with me ;

5 I further declare and represent that I have no plans nor will I voluntarily sell my property for at least three years and that no promise or agreement not herein expressed has been made to me, and that this release contains the entire agreement between parties hereto, and that the terms of this release are contractual and not a mere recital. I further state, subject to disqualification, that I have truthfully completed the foregoing APPLICATION and that I have carefully read the foregoing CONDITIOND, CONSENTS, and RELEASE and understand the contents thereof, and that I sign as my own free act. Print Homeowner Name: Homeowner Signature: Print co-homeowner Name: Co-Homeowner Signature: Please attach a copy of your last Tax bill to this application. You may whiteout the numbers, but not the names. ALL APPLICATIONS MUST BE RETURNED BY JULY 1, 2015 LATE APPLICATIONS WILL NOT BE ACCEPTED