2005 AGN SEP 06 I26 - Laserfiche WebLink

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Briefly describe the work you plan to complete and the estimated cost. Please include paint samples, Application of Funds pictures and a drawing of planned improvements, if necessary. You are not required to furnish -;i:, information, but are encouraged to do so. The law provides Demographic Information that you may not be discriminate) Dn the basis of this information, nor on whether you choose Applicant Race/National Origin ❑ 1 do not wish to provide this information ❑ American India or Alaskan Native ❑ Asian or Pacific Islander ❑ Black, not of Hispanic origin ❑ Hispanic ❑ White, not of Hispanic origin ❑ utner (speciry) Gender ❑ Female ❑ Male Everything that you have stated on this application is correct to the best of your knowledge and you acknowledge you are legally of age to enter into this transaction. You understand that the Agency will retain this application whether or not it is approved. You also understand that this application will be used to determine whether or not you qualify for the grant and completion of this application does not mean that you have been approved for the grant. You also understand that if approved, the Agency will reimburse you up to $2 for every $1 you contribute to the approved improvements. The Agency's maximum contribution is $2,000. Applicant's Signature Date Please return this application and any pictures, paint samples or drawings for the proposed improvements along with: Tax Returns for past 2 years Most recent paycheck stubs covering last 30 days Last 3 months bank statements for all checking, savings, IRAs and 401 (k) accounts Addresses of other real estate owned Loan information on all real estate owned Mail your complete application package to: Rancho Mill Home Beautification Grant Program 650 N. La Cadena Drive Colton, CA 92324 8/30/2005