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Driveway and Private Sidewalk Restoration Reimbursement Application

 

 

The information provided is accurate to the best of my knowledge on the date this application form was submitted.

I understand that, if I qualify for compensation, the compensation amount will be based on the approved fixed amount that was in effect at the time this application was received.

By submitting this application/form you acknowledge and agree that any electronic signature provided by you herein is the same as a handwritten signature for the purposes of legality, validity, enforceability, and admissibility.

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