HARDSHIP REIMBURSEMENT POLICY APPLICATION FORMS FOR

THE LAKE MERRITT/UPTOWN DISTRICT ASSOCIATION - COMMUNITY BENEFIT DISTRICT
November 2008
The following form shall be used by Lake Merritt/Uptown District Association CBD
assessed property owners interested in applying for a “Hardship Reimbursement”.
Please fill out the form completely and review the attached policy for clarification of
eligibility with this program.
1. Name of Applicant Property Owner Company:
________________________________________________________________________
2. Name of Owner or Authorized Rep: __________________________________
3. Street Address of Applicant Property Owner:
________________________________________________________________________

4. Parcel(s) requested to be reimbursed for Lake Merritt/Uptown CBD
assessments this year:
________________________________________________________________________
5. Amount of Assessment Paid this Year: ________________________________
(Please show proof of CBD payment made to County)

6.

Amount Requested to be reimbursed through the Hardship Policy: (Partial, full, etc.)
$___________________________________________________

7.

Reason for Request: (Please use one of the rationale identified in policy)
(3) “The Organization/Executive Committee shall make its recommendations
to the full Board of Directors based upon the following criteria:
a. Determination that the request for reimbursement relief is based upon
genuine economic hardship and inability to afford the CBD’s annual costs;
and
WHEREAS the Lake Merritt/Uptown District Association seeks to improve the
Lake Merritt/Uptown area with the special benefits funded from the new CBD,
LAKE

MERRITT/UPTOWN

COMMUNITY
CT

BENEFIT

DISTRI

388 19th Street  Oakland, California 94612
Phone 510.452.4529 Fax 510.452.4530  info@lakemerritt-uptown.org  www.lakemerritt-uptown.org

however, does not seek to create hardship for disabled, senior or other
individuals, non-profit/tax-exempt organizations or those property owners who
currently lack the means to pay into the Lake Merritt/Uptown Community
Benefit District”
Reason for request for Hardship reimbursement from the Lake Merritt/Uptown District
Association:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Recommendation for documentation by the LMUDA Organization Committee:
Request for Documentation by Organization Committee:
 Last 2 year tax returns:

Yes

No

 List of properties owned within or outside of Lake Merritt

Yes

No

 Last 2 years operating statements for each parcel

Yes

No

 Most current 2 years of bank statements on parcel

Yes

No

Organization Committee Recommendation: ________________________________
____________________________________________________________________________
Board Action:
Date of Action:
Comments:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________