The application has been created to assist in allocating the funds that have been raised through the generosity of the community.

Family Service Association has been the agency designated to account for the gift cards, cash and check donations.

We encourage all those that have been impacted by the December 9th explosion on Richards Avenue to complete the attached application.

There is no deadline to complete the application, but we do intend to distribute the funds in a timely manner. Therefore we encourage you to complete the application as soon as it is convenient for you.

Please provide as much information as you can to provide the committee with the most accurate information on your expenses and those items that have financially impacted you through the disaster.

Feel free to attach additional pages, receipts, insurance documents and/or estimates of repairs. Please be as concise as possible as to the expenses you incurred and may still incur in the future that insurance won’t cover.

Patricia Leonard at Family Service Association is more than happy to answer any questions or concerns you may have about the application. She can be reached at 607-432-2870

Emergency Request Form