Bay
Restoration
Fund
(BRF)
Proposed program
for
exempting certain residential users from paying the
BRF
fee because
of
substantial financial hardship
Proposed financial hardship exemption criteria
Application procedure and forms (please attach
forms)
Required supporting documentation
for
eligibility
determination
Exemption time period ana process
for
re-
verification
of
eligibility
Estimated number
of
residential users
that
may
qualify
for
exemption.
Name/Signature
of
Authorized Official
Documentation
of
approval
of
State Energy
Assistance from Office
of
Home Energy Program
(OHEP)
for
the current fiscal year;
OR
documentation
of
two
of
three criteria below
must
be
provided
to
qualify
for
an
exemption.
1. Receipt
of
public assistance
or
food
stamps within the last
12
months.
2.
Receipt
of
Veteran's
or
Social Security
Disability Benefits within the last
12
months.
3.
Meet
minimum income criteria
established by
OHEP
and demonstrated
by a current year's tax return
or
an
executed income certification.
Under a new State approved City
of
Bowie customer assistance program, low-
income eligibility will
be
primarily based
upon approval into the State
OHEP,
and
identification
of
a corresponding City
of
Bowie residential account.
Approval under
the
City
of
Bowie
Customer Assistance Program will
automatically satisfy
two
of
the
MDE
criteria;
OHEP
and minimum income.
Application form
for
direct assistance
in
lieu
of
OHEP
participation
is
attached.
See
attached application and income
certification.
Exemption will
be
granted
for
the City
of
Bowie
fiscal year (July
1-
June 30). Residents must re-
apply each fiscal year beginning July 1
to
verify
continued eligibility.
It
is
anticipated
that
100 residential users could
qualify
for
Alfred D. Lott, City Manager
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City:
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
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
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
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
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
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
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






I understand
that
,
if
approved, this exemption will apply to the property in which I
am
living,
as
identified on this application, and will
be
valid until
June
30,
__
.
Signed
Name_______________
Date
____
_
For Official
Use
Only
Exemption Approved:
__
Exemption Not Approved :
__
By:
-
-------
Date:
----
CITY
OF
BOWIE RESIDENTIAL
BAY
FEE
EXEMPTION PROGRAM
CERTIFICATION
OF
HOUSEHOLD INCOME (CRITERIA NO. 3)
I,
(print
full
name)
________________
_,
am
the
owner/tenant
(circle one)
at
__________________
(property
address),
which
is
City
of
Bowie
Account#
There are
(number
of
occupants)
__
people residing
at
this
property
.
Occupant's
Name
Age Source
of
Income*
Gross**Monthly
Income
$
$
$
$
$
Total
Monthly
Household
Income
*Source
of
income
may
include
employment
income,
social
security/veterans'/disability
or
other
government
assistance
programs.
**Gross
income
is
income
from
employment
before
deductions
by
the
employer
for
taxes, social
security, etc.
Documentation
required
: Please
attach
documentation
(tax returns, pay stubs,
government
benefits
statement,
etc.)
to
support
all
income
listed above.
I
HEREBY
CERTIFY
UNDER
THE
PENALTY
OF
PERJURY
THAT
THE
INCOME INFORMATION PROVIDED
HEREIN
IS
TRUE
AND
CORRECT
.
Printed Name:
________
_
Signature:
__________
_
Date:
____________
_
PLEASE
RETURN
THIS CERTIFICATION
TO
THE
CITY
OF
BOWIE DEPARTMENT
OF
FINANCE, 15901
Excalibur Road, Bowie,
Maryland
20716.
click to sign
signature
click to edit