CITY OF ALLEN PARK COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM 2014 SMOKE DETECTOR DISTRIBUTION

Distribution Managers:

Allen Park Fire Department 6730 Roosevelt Avenue Allen Park, MI 48101 313-928-0024

Date: Resident Name: Street Address: Telephone: DOB: RACE: ________________________________________________

NUMBER OF SMOKE DETECTORS RECEIVED: Female Head of Household: YES NO

Please Circle the financial data that best describes your household:
FY 2014 Income Limit Category Extremly Low (30%) Income Limits Low (50%) Income Limits Moderate (80%) Income Limits 1 Person $13,600 $22,650 $36,200 2 Person $15,550 $25,850 $41,400 3 Person $17,500 $29,100 $46,550 4 Person $19,400 $32,300 $51,700 5 Person $2,100 $34,900 $55,850 6 Person $22,550 $37,500 $60,000 7 Person $24,100 $40,100 $64,150 8 Person $25,650 $42,650 $68,250

Please note that the above information will remain confidential to the public. Your disclosure is only to ensure the Block Grant program is serving the clients mandated by the U.S. Department of Housing and Urban Development. Should you have any questions, please contact: Mark Kibby City of Allen Park CDBG Program Coordinator Cdbgconsultant2013@yahoo.com