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Benevolence Fund Application
Application for Assistance
Your name
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Last name
Email address
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Phone number
Phone type
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PAYEE INFORMATION
Payee Name
Payee Address, City, Zip Code
Payee Phone
Account Number
Amount Due
Purpose
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Mortgage/Rent
Utilities
Medical Services
Vehicle
Other
Date Due
Date
UPLOAD BILL(S) IF APPLICABLE
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Explanation of Need
Please explain in detail.
Amount Requested
General Information
Is recipient an, or related to any employee, officer or board member of the Church?
Yes
No
Has recipient received assistance from the Church?
Yes
No
What steps have been taken to obtain assistance from non-church sources?
Signature
I hereby declare that the information above is true and complete.
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