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Downtown   Revitalization     Improvement   Program   Loan  Application  

  Date  of  Application:    ______/______/______     Applicant  Information     Applicant  Name:    _________________________________________________________     Business  Name:    __________________________________________________________     Street  Address:    __________________________________________________________     City:    ________________________________    State:    _______    Zip:    _________________     Phone  Number:    ________________________        Fax:    ____________________________     E-­‐mail  address:    __________________________________________________________     Building  Information     Address  of  building  where  work  is  to  be  done:    _________________________________     Years  in  Business:  _________                    Property  is:    ____  Occupied  by  Owner          ____  Leased     Name  of  Tenant  if  Leased:    __________________________________________________     Financial  Information     Estimated  Cost  of  Improvements:    $_________            Total  Amount  Requested  $_________     Requested  Payment  Structure:    ______________________________________________     Existing  Loans  Payable  (Property  Owner)     Creditor  Name  &   Original   Loan  Date   Term   Interest   Outstanding   Collateral   Account  Number   Amount   Mo/Yr   Rate   Balance                  

 

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Improvement Information     Types  of  Improvements  Planned  (check  all  that  are  applicable):     _____  Stationary  Fixtures         _____   Plumbing           _____  Structural  Alterations         _____  Electrical  Work           _____  Wall  Improvements         _____Flooring                   _____  Other  (describe)  _____________________________________________________     Brief  Description  of  Improvements  to  be  made:     ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________   Please  attach  the  following:       1. Two  separate  cost  estimates  from  licensed  contractors  (if  work  can  be  done   locally,  we  encourage  bids  to  be  sought  from  Dodge  City/  Ford  County  Vendors)   2. Drawings  that  show  work  to  be  done  (if  applicable)   3. Pictures  of  building  in  present  condition                     2  


WAIVER OF  LIABILITY     I  agree  to  the  repairs  proposed  in  the  attached  estimate  and  hereby  release  Main  Street   Dodge  City  and  the  City  of  Dodge  City,  from  any  and  all  claims  of  liability  arising  from  the   Downtown  Revitalization  Façade  and  Exterior  Improvement  Grant  Program.         _____________________________                              ___________________________   Date               Signature  of  Property  Owner         _____________________________       _____________________________   Date               Signature  of  Business  Owner           Date  received  by  __________________________  by  _____________________________       ECONOMIC  RESTRUCTURING  COMMITTEE  RECOMENDATION     APPROVED          OR      REJECTED        Signature_____________________  Date  _________     Notes:       DESIGN  COMMITTEE  RECOMENDATION     APPROVED          OR      REJECTED        Signature_____________________  Date  _________     Notes:         FINAL  APPROVAL  (MAIN  STREET  BOARD  OF  DIRECTORS)     APPROVED          OR      REJECTED        Signature_____________________  Date  _________     AMOUNTED  AWARDED:    $___________________  

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Loan Application  
Loan Application  
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