Abatement Request - Form - Farmington Valley Jewish Congregation

ABATEMENT REQUEST FISCAL YEAR: 2023-2024

GENERAL INFORMATION ABOUT ABATEMENT REQUESTS:
Please know that this abatement process is strictly confidential. We ask that you complete the entire form each year you are requesting an abatement. Your request will be reviewed by the FVJC Vice President in charge of abatements, the President and the Treasurer. For current members, requests should be received by September 3 each membership year. Requests can also be made as circumstances change or upon joining FVJC.

All questions regarding abatements should be directed to Jeremy Greshin 2nd Vice President at jeremy.greshin@comcast.net

- STRICTLY CONFIDENTIAL -

PERSONAL INFORMATION

* First Name

* Last Name

* Email

* Phone

Best time to call:

Number of years at current residence

* Own or Rent?

FAMILY INFORMATION

Please let us know if any of your children are currently enrolled in private school or college, and if so, please explain any financial assistance you are receiving for their education

ABATEMENT INFORMATION

Have you requested an abatement before?

* Please explain any extenuating circumstances to help us understand your financial situation and you’re request for an abatement

FINANCIAL INFORMATION

Please describe any other income

Do you receive government assistance?

EMPLOYMENT INFORMATION

Name of employer

Address of employer

Full timePart timeNot employed

Name of spouse/partner's employer

Address of spouse/partner's employer

Full timePart timeNot employed

OTHER MEMBERSHIPS

Please list any outside recreational memberships (golf, tennis, swim, health clubs), etc.

For Executive Board Use Only

Total Obligation $

Approved Total Adjusted Obligation $

Date of approval

Approved By (Name)

Date Abatement Posted