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3. Economically Disadvantaged PolicyEconomically Disadvantaged Policy The Kalispell City Council hereby establishes a special policy for the economically disadvanta ed for the purpose of providing annual financial relief to those Wffected by assessments resulting from the City Council ordering in certain public improvements such as sidewalk and curbing. An economically disadvantaged widow or widower is defined as a person whose total income, earned or unearned, is not more than ; per month, including income from bonds, stocks, savings interest or other interest or dividend 41 income of any kind, and who: 1. generally derives his income from social security or a pension program; 2. owns no real property other than his/her home; 3. is dependent upon his own resources for support; 4. is living alone or with members of his/her family who are dependent on him for support, and; S. is at least 65 years of age. Economically disadvantaged elderly couples are defined as the same as above except that the total household income does not exceed AfCO $ per month and that one member of any elderly couple must be at least 65 years of age. Application for the economically disadvantaged widow, widower, or elderly couple shall be made to the City Finance Director and the applicant shall make a sworn statement of his income and financial resources; such application shall be referred to the City Council for final determination of the qualifications of the applicant. upon proper. determination by the City Council, the applicant shall be relieved of that year's special assessment levied for the purpose of paying for sidewalk and curbs. It shall be the duty of the individual who has been granted the economically disadvantaged widow, widower, or elderly couple status to inform the City Finance Director of any change in the status affecting his/her qualifications for any future annual special sidewalk and curb assessment relief. Application for ECONOMICALLY DISADVANTAGED POLICY Name Address Phone No. Social Security No. *Check All Boxes That Apply* Widow or Widower ❑ Live Alone El Live with family who are dependent on me for support Over 65 ❑ Total household income under $ per month Elderly Couple One spouse over 65 El Total household income under $ per month I hereby certify that the above information is correct to the best of my knowledge and that I will inform the City of Kalispell of any change of my status affecting my qualifications for assistance under this program. I also certify that I own no real property other than my home. (signature of Applicant) Approved By: (signature of City Manager) (Date) (Date)