SECTION 1
Dear Applicant:

Thank you for applying to the Handy Helper Program.  Enclosed is an application form.  Please fill out and return it along with a copy of the following:

1.	Currently dated verification of all income including, but not limited to: 
•	Social Security
•	SSI
•	Pension
•	Disability
2.	A copy of your most current income tax return 
3.	Proof taxes are current and that the applicant owns the home.

Should you have any questions, please do not hesitate to call John Kozak, the Program Coordinator at 856.488.7855.

Sincerely,

Bernie Platt
Mayor






SECTION 2
HANDY HELPER PROGRAM
SUMMARY

Our Handy Helper Program can help income Qualified Senior Citizens and Medically Certified Disabled Residents with minor home repairs.  All repairs are FREE of Charge!


•	Qualified contactors can install smoke detectors and locks, repair doors and sidewalks, fix faucets and other minor problems in your home.  Out “Handy Helper” Program has earned the praise of seniors in the neighborhoods all over town.

•	Income qualified senior citizens and medically certified disabled homeowners and condo owners are eligible.


Number of Persons in Household		  Maximum  Income Limit
1						$0-$40,400
2						$41,401-$46,150
3						$46,151-$51,950
4						$51,951-$57,700
5						$51,701-$62,300





SECTION 3
HANDY HELPER APPLICATION

Name:
Address: 											
Home Phone:
Block/Lot:
Date of Birth:
Social Security #:
0	Female Head of Household
0	Over 62
0  	Hispanic


0  White 	0  Black	0  Asian	0  Other ______________________	


Are your taxes paid to date?     0 YES         0 NO

MEMBERS OF THE HOUSEHOLD (Including Yourself) 
Family Member Name	Social Security #	Monthly Salary
		
		
		
		
		

Total Persons:  		Total Income:  				 	


Number of Persons in Household			  Total Income
0	1						0	$0-$40,400
0	2						0	$41,401-$46,150
0	3						0	$46,151-$51,950
0	4						0	$51,951-$57,700
0	5						0	$51,701-$62,300


I certify that the above information is complete, true and correct to the best of my knowledge and belief.
					
							
Applicant’s Signature:

________________________________________




I have seen the income documentation and found that, according to the information provided by the applicant, HE/She DOES/DOES NOT meet income eligibility criteria for participation in this program.
							
Signature of Program Director:

________________________________________


0	Accepted 
0	Declined												
Date:





SECTION 4
HANDY HELPER PROGRAM
CERTIFICATION OF INCOME


I,______________________________, an applicant to the Cherry Hill
        applicant's name

Township Handy Helper Program, certify that my total annual gross family 

income is $________________ and that I have not filed a United States Internal 

Revenue service 1040 Tax Return or a New Jersey division of taxation tax 

return within the past two (2) years.


Do you receive a pension?		0 YES         0 NO		

Amount $: 			

I further understand that the information provided on this affidavit will 

determine my eligibility to participate in the program.


							
Applicant’s Signature
					
Date
Sworn to before me this ___________
day of ____________, 20___.


____________________________________	
Notary Public