Alternative Heating/Wood Program

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.
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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