Check the applicable cause of economic hardship if you or a person in your household has experienced a loss of income due to the COVID-19 pandemic (check all that apply)
I desire to receive any assistance to which I am legally entitled under this program and its specifications. I certify that the reason I am eligible for this CARES Act assistance is correct to the best of my knowledge and belief.
I understand that my signature on this form gives permission for the staff at Hanover County to verify records as necessary to verify my eligibility for assistance.
I declare to the best of my knowledge that:
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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