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Butte Microbusiness COVID-19 Relief Grant Application

Butte Microbusiness COVID-19 Relief Grant Application
MM slash DD slash YYYY
Primary business owner’s name(Required)
List names of other business owners (if any) with 20% or more ownership of the business
Name
Ownership %
 
Business street address (MUST BE LOCATED IN BUTTE COUNTY)(Required)
Business mailing address (if different)
Did this business receive an award from the California Small Business COVID-19 Relief Grant Program?(Required)
MM slash DD slash YYYY
Business type(Required)
Primary owner gender (optional)
Primary owner ethnicity (optional)
Is the primary owner a veteran? (optional)
How do you plan to use the $2,500 grant (check all that apply)(Required)
Max. file size: 50 MB.
Current/valid business license OR Fictitious Business Name Statement OR Seller’s Permit OR current business bank statement OR 2019 Federal Tax Returns
Max. file size: 50 MB.
I certify that I am the majority-owner and manager of the business and that it was my primary means of income during the 2019 taxable year.(Required)
I certify that I am authorized to sign on behalf of all owners listed in this application.(Required)
I authorize 3CORE to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness.(Required)
I declare under penalty of perjury that all the information submitted in this application is true and correct.(Required)

Digital Signature

By typing your full name below using any device, means or action, you consent to the legally binding terms and conditions of this program. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.

The CA Microbusiness COVID-19 Relief Grant Program is administered by 3CORE, Inc.