REALTORS® RELIEF FOUNDATION Application for Wildfire Disaster Relief Assistance A wildfire disaster relief fund of just over $25,000 is now available from the REALTOR® community. The purpose is to assist individuals and families in Idaho whose primary residence was destroyed or damaged by a wildfire in 2015.
Type of Assistance Grants are available for qualified applicants, whose primary residence (located in the state of Idaho) was damaged or destroyed by a wildfire in 2015, to offset their monthly mortgage expense or the cost of temporary shelter due to displacement from said residence. Grants will be limited to one month of assistance, up to $1,000 per applicant, and one grant per residence. The deadline for submitting this application is April 1, 2015. This assistance is for housing relief only; other expenses such as a vehicle purchase, rental, repair and/or mileage are ineligible for reimbursement under this program.
Eligibility Recipient must be a full-time resident of the state of Idaho and a United States citizen (or legally admitted for residence in the United States). Applications will be reviewed without knowledge of the identity of the applicant.
Confidentiality All information provided on this form by the applicant will remain confidential and will only be available to those who need to confirm eligibility and to those who process the grant payments. This includes providing a copy of this application to the applicant’s lender or landlord, if requested. It will not be shared with other parties for any other purpose.
Disbursement of Funds In order to provide for a reasonable and equitable distribution of funds, grants will be provided on a first come, first served basis. All grants are contingent upon the availability of funds. Grants will be jointly payable to applicant and mortgage lender or landlord. The REALTORS® Relief Foundation reserves the right to accept or reject any application and, or to cancel any grant for good and sufficient reasons. The Foundation also reserves the right to change the application criteria at any time.
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REALTORS® RELIEF FOUNDATION Application for Disaster Relief Assistance Please complete all information to be considered for assistance. Full Name: Email Address: Street Address (including unit # if applicable) of the damaged or destroyed property, which you affirm is your full-time residence:
City:
State:
Mobile Phone:
Other Phone:
Type of Dwelling:
Single Family
ID
Zip Code:
Condo/Townhome
Other (specify):
Do you own or rent this property?
Own
Rent
Is this your primary residence?
Yes
No
Total Estimated Loss:
$
Estimated Uninsurable Loss:
$
Do you have an insurance estimate? Please attach if so.
Yes
Have you been displaced from your primary residence?
No
Yes
No
Mortgage
Temporary Housing
If yes, estimated length of displacement: Type of Assistance Requesting:
For Mortgage Assistance: Name of Lender/Mortgage Servicer: Payment Address: Website Address: Telephone #: Mortgage Loan Account #: Monthly Payment: $ REQUIRED: Attach a copy of your last mortgage statement, including payment amount and balance owed. Please note these copies will not be returned, so please do not submit originals.
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For Temporary Housing Assistance: Name of Landlord/Shelter Provider: Payment Address: Telephone #: Monthly Payment: $ REQUIRED: Attach a copy of your rental agreement or proof of temporary housing costs (receipts). Please note these copies will not be returned, so please do not submit originals.
Provide a brief description of the damages that your primary residence has incurred:
Detail any financial assistance that you have received from other sources: Provider
Description of Assistance
Amount Received
Declaration of Applicant By signing this application, I verify that all information presented is true and correct to the best of my knowledge. I understand that the Idaho Association of REALTORS速 may request additional information before approving this request. (Unsigned and/or incomplete applications will not be accepted.) Printed Name of Applicant: Signature of Applicant: Date: Address to which check should be mailed:
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Full Name: Address: City: State:
Mail or email the completed application and required attachments to:
Zip:
Idaho Association of REALTORS速 Attn: La Dawn Anderst 10116 West Overland Road, Boise, Idaho 83709 Email: landerst@idahorealtors.com For Inquiries: 1-208-342-3585
For Idaho Association of REALTORS速 Use Only We have reviewed the attached Wildfire Disaster Relief grant application and recommend to the REALTORS速 Relief Foundation that it be considered for funding. Recommended Amount:
$
Special Notes: Signature of President or CEO:
For REALTOR速 Relief Foundation Use Only Date Received:
Amount Approved/Processed:
$
Reviewed By: Date Approved: Special Notes:
Revised February 11, 2016
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