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3. Name*
4. Email Address*
6. Address*
8. City*
9. State*
10. Zip Code*
12. Phone Number*
14. Number of persons which occupy the residence*
15. Estimated annual household income*
16. Estimated $ contributions by the homeowner*
18. Type of work performed (or to be performed) with homeowner's contribution:*
20. PLEASE ATTACH THE FOLLOWING:
22. Proof of Ownership (Quitclaim or Warranty Deed)*
23. 2 months recent paystubs of all employed occupants of the household (18+)*
24. Request for Taxpayer Identification Number (W-9)*
26. Two recent months of checking/savings account statements for all occupants*
27. A written bid, breaking down the cost of the project, from the contractor performing the work*
29. If there are more than one employed occupant 18+ years of age, please upload previous year's tax return for each individual:
31. Previous year's tax return*
32. Previous year's tax return*
33. Previous year's tax return*
35. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that you have reviewed Ordinance No(s). 2016-27 and 2016-53 and understand the terms and conditions and further allow the City to verify all the above information in order to ensure that the program requirements are met. Submission of this application does not in itself obligate the City or Home Owner without execution of the agreement.

    1. I agree.
37. Electronic Signature*
39. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature*
42. Date*
44. Curb Appeal Assistance Application Approved By:
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48. Submit

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