Marion Community Fund Application

Marion Community Fund Application

Completed Applications Must be RECEIVED at the

Community Foundation of Southeastern Massachusetts

30CornellStreet

New Bedford, MA 02740

ON or BEFORE 5:00 p.m.Monday, October 2, 2017

All grants will be paid to the Town of Marion – Collectors Office - on behalf of grant recipients and credited toward the grant recipient’s tax bill.Any ungranted funds will be returned to the Community Foundation of Southeastern Massachusetts. Please note the following Income and Asset requirements: Income limit: Single - $25,000, Married - $37,500. Asset limits: Single $46,000, Married - $63,000 (excluding your home).

1) Complete all sections fully

2)Attach a copy of your property tax bill

3) Attach a copy of your 2016 Federal Income Tax Return OR

Initial here: ______I did not file a federal tax return for 2016 because my income level did not require it.

Name of Applicant: ______Marital Status: ______

Number of dependents living in the home (do not include yourself) ______relationship ______

Legal Residence on January 1, 2016______

Mailing Address (if different)______Tel. # ______

Location of Property ______

Number of Dwelling Units ______Parcel/Map and Lot# ______

Did you own the property on January 1, 2017? Yes NO 

If Yes, were you Sole Owner  Co-Owner with Spouse ONLY  Co-Owner with Others? List name of others and relationship______

Was the property subject to a trust as of January 1, 2017? Yes NO 

If Yes, attach trust instrument including all schedules.

Have you owned and occupied the property as your primary domicile for at least 1 year?

Yes NO 

If No, list the other properties you owned in the past 3 years.

AddressDates OwnedOccupied

______

______

Did you receive fuel assistance last year? Yes  NO  Amount received ______

Were you granted a property tax exemption, last year (do not include any funds received from last year’s Marion Community Fund)? Yes  NO  Amount received ______

Gross Receipts from all income producing sources in preceding calendar year:

Applicant Spouse &/Co-owner Total for Year

YearlyRetirement Benefits (Social Security)$______$______$______

YearlyOther Pensions & Retirement Allowances$______$______$______

YearlyDisability Income$______$______$______

YearlyChild Support$______$______$______

YearlyWages, Salaries and other Compensation$______$______$______

Yearly Profits from Business or Profession$______$______$______

Interest and Dividends**If your tax return has greater than $400.00 in interest and dividends, you must provide schedule B whether on tax return or not.

$______$______$______

Any Other Income (Rent, Capital Gains, etc)$______$______$______

Yearly Totals (all above categories)$______$______$______

VALUE OF PROPERTY: Documentation may be requested to verify your assets.

Real Estate:Assessed ValuationAmount Due on Mortgage

Domicile______

All Other______

PROPERTY TAX TOTAL FOR FY16(Please be sure to include your property tax bill): $______

This application has been prepared or examined by me. I declare that to the best of my knowledge and belief, it and all accompanying documents and statements are true, accurate, and complete.

______

Signature of ApplicantDate

The Community Foundation of Southeastern Massachusetts will hold all information contained in or with this application in confidence. All grants will be paid to the Town of Marion – Collectors Office - on behalf of grant recipients and credited toward the grant recipient’s tax bill. Decisions will be made by December 15, 2017.If you have any questions, please do not hesitate to contact the Community Foundation at 508-996-8253.

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