2024 Wood Program Form

WATERFORD RECREATIONS AND PARKS COMMISSION 
Wood Program 2024-2025 
October      , 2024 
 
Dear _______________________,  
 
The Waterford Recreation and Parks Commission has received your request for the Senior Citizens’ 
Wood Delivery Program.  Delivery of the wood expected start date of December 1st. 
 
To verify your income eligibility please fill out the information section below and return it to us at: 
Waterford Recreation and Parks, 15 Rope Ferry Road, Waterford, CT 06385 either by mail or stop by the 
office.  If you have any questions or would like further information on this program please call us at 860-
444-5881. 
============================================================================================================================ 
 
Name:  
 
 
 
 
 
 
 
 
 
 
 
Address: 
 
 
 
 
 
 
 
 
 
 
 
 
Phone:  
 
 
 
 
 
 
 
 
 
 
 
Are you a Waterford Resident: 
Yes  
 No  
         
Are you 65 years old or older:  
Yes  
 No  
 
 
Do you live alone: 
 
 
Yes  
 No  
 
 
 Single - is your total adjusted income, according to your income tax return, including social security 
payments, less than $45,505.00. 
 
 
 Double - is the combined total adjusted income, according to your combined income tax return, 
including your combined social security payments, less than $59,507.00. 
 
Signature:  _____________________________________________ 
 
Date:    
 
 
 
 
Applicant 
 
If you are Under Age 65, do you receive full Social Security Disability? Yes 
No  
 
 
 
Do you have a Fire Place   
     Wood Burning Stove   
 
 
Do you have a Disability   
  if yes, please explain:   
 
 
 
 
 
 
 
 
Signed    
 
 
 
 
 
 
 
_________ 
 
 
 
Ryan McNamara, Director, Waterford Recreation and Parks