Recycling Assistance Application

Project Renewal

Amy Bliss, Executive Director 301 N Broom Street, Suite 101, Madison, WI 53703 (608) 255-3131 Phone (608) 255-5595 Fax [email protected] Email

Mobile Home Disposal or Recycling Assistance Application In order to assess the availability for funding assistance in recycling your mobile home, we need you to answer the following questions:

1) Address of the Home Owner

Homeowner Name ______Current Address______City, State, Zip______Phone (H)______Fax ______(W)______

2) Home Location

Address ______City, State Zip______County home is located in______

3) What is the nearest road the home is located by? This criterion helps us understand the degree of visual pollution caused by this home: the closer the home is to a major highway the more severe the visual pollution.

4) Are you the homeowner? _____ All homes must be owned by the applicant or a legal heir. Does any Town, City, State, County or DNR official support this application? ______If so whom? ______Phone #______Address ______City, State, Zip ______

Annual Income of Household $______(Used to determine funding assistance)

(You must include a copy of last year’s tax return, social security benefits statement or other proof of income.) 2

5) Home Specifications Size of the Home? ______Make______Model______Year______(Example: 14 X 70)

6) Did this home ever have central air-conditioning? ______

7) Is there a refrigerator currently inside the home?______The home must be Freon free—which means no refrigerators, freezers, air conditioners or dehumidifiers.

8) Are you willing to completely empty the home?______The home must be free of all floating debris including trash, rolls of carpeting, clothing, furniture or any miscellaneous debris of any kind.

9) Is the home free of asphalt shingles? ______This is also important information that affects the transportability and recycle-ability of the home.

10) Do you have the title for the home?______

11) Date the home(s) will be ready for processing? ______

13) How did you hear about our program? ______

Disposal or Recycling Process What applicants can expect

Step One: Application and all supporting documents must be mailed to Tomorrow’s Home Foundation. Include: Application – Completely filled in Title or other proof of ownership Estimates for demolition, recycling or disposal

Step Two: Tomorrow’s Home Foundation staff will verify the most feasible, environmentally friendly and economical method for disposal. If required, environmental hazards will be identified. Cost estimates will be determined. (This process could take at least three weeks.)

Step Three: Tomorrow’s Home Foundation staff will contact the applicant to discuss scheduling and best method of disposal.

Step Four: If the homeowner approves the project, they must provide 10% of the total project funding to the transporter or the disposal or recycling facility. (This process will be determined by Tomorrow’s Home Foundation staff.)

Step Five: The home will be disposed of and Tomorrow’s Home Foundation will pay the balance of the charges directly to the service providers. 3

301 N Broom St., Suite 101, Madison, WI 53703 Phone (608) 255-3131 Fax (608) 255-5595 Email [email protected]

Project Renew Rules and Regulations

The following rules and regulations are mandatory for participation in the Tomorrow’s Home Foundation recycling program. In the event the rules are violated in any way, the home will be refused by the transporting company or recycling company.

 In order to participate in the recycling program, the Tomorrow’s Home Foundation must have this signed agreement on file stating that program rules will be followed.

 All home disposal or recycling will be scheduled by the Tomorrow’s Home.

 No homes containing trash, rolls of carpeting, clothing, furniture or any other miscellaneous debris will be accepted.

 Homes must be freon free – No refrigerators, freezers, air conditioners, or dehumidifiers.

 All capacitors, ballasts, and mercury switches must be removed and properly disposed of. (Furnace blowers, thermostats, fluorescent lights, etc.)

 All utilities (electrical, telephone, gas, water, cable, etc.) must be unhooked so the home can be transported.

 All attachments (steps, porches, carports, etc.) must be removed.

 All skirting must be removed.

 A copy of the title should be submitted to the Foundation office along with this form. If you do not have a title for the home, please sign the statement below confirming that the home is unusable for housing and the value of the home is $0.

 All other landfill or recycler restrictions will be followed. (These restrictions will be listed with specific landfill or recycler.)

Agreement In consideration of, and as a condition of participation in, the Tomorrow’s Home Foundation Disposal and Recycling Program, the undersigned participant agrees to abide by all of the above stated rules and regulations of the Tomorrow’s Home Foundation or disposal facility. By my signature, I confirm that the value of the home is $0 and I am requesting destruction of the home identified in this application.

______Signature of participant Date