Laserfiche WebLink
anaa <br />SOWTLA <br />HOME OF PELICAN BUND <br />COVID-19 RECOVERY & STIMULUS PLAN FOR SMALL BUSINESSES WORKER <br />GRANT APPLICATION <br />Legal Name of Small Business: <br />Legal Name of Worker: <br />Worker's Email Address: <br />Worker's Home Address: (Must Reside in Sebastian). <br />Worker's Mailing Address: <br />Worker's Phone Number: <br />Describe Your Job (Including the Average Hours per Week You Worked Prior to March 1, 2020): <br />Describe the Economic Loss You Have Suffered: (Must Have Experienced a 25% Loss of Income to Qualify). <br />By signature of this application, the Above Worker agrees that this application and other relevant documents <br />are subject to verification by the City and may be shared with internal and external stakeholders. Also by <br />signing below, the Small Business Owner and Worker hereby certify that the Worker worked for the small <br />business an average of 20 hours per week or more prior to March 1, 2020 and has lost at least 25% of their <br />income due to the negative impacts of the COVID-19 Pandemic: <br />Small Business Owner's Name: Worker's Signature: <br />Primary Owner's Signature: <br />Date: <br />Documentation Required With This Application: <br />1. A Copy of Worker's Current Driver's License, Current Passport or Other Photographic Identification. <br />2. Evidence of being past due on rent, utilities or other essential expenses for an amount greater than <br />$500.00 is required to receive a priority ranking for the disbursement of the available grant funds. <br />3. A Completed and Signed IRS Form W-9. <br />