Form Center

2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Email Address*
14. What project are you applying for?*
    -- Select One --Tree TrimmingNew or Replacement TreeBoth
18. **New/Replacement Tree**
20. Describe the tree(s) being removed (size and species) and include a map with aerial photography and lot lines indicating the location of the tree(s) being removed as well as the proposed location of the new tree(s). A map can be generated with this information using the https://aims.jocogov.org website. *
22. Upload Map Here
24. Have you applied for reimbursement through Johnson County Contain the Rain?*
26. Installation Questions

    1. I have provided a photo of the proposed planting location before installation
    2. I will provide reciept(s) for purchase and/or installation (required for reimbursement from the city)
    3. I will provide a photo of the proposed planting location before installation
30. **Tree Trimming**
32. Describe the size and species of the tree(s) you wish to trim and provide a map with aerial photography and lot lines indicating the location of the tree(s) being trimmed. A map can be generated with this information using the https:aims.jocogov.org website*
34. Upload Map Here
36. Installation

    1. I have provided a photo of the tree(s) before trimming
    2. I will provide a photo of the tree after trimming (required for reimbursement from the city)
    3. I will provide a reciepts(s) for trimming (required for reimbursement from the city)
38. What is the estimated cost of trimming?
42. For Income Eligible Applicants Only:
44. Do you need the City to assist with the purchase of a tree or tree trimming services? In other words are you asking the City to pay a contractor directly?
46. Number of people in the house hold
48. List all your income sources and amount of income received from each source during your claim period
50. Will you be filing an Income Tax Return

    1. Yes
    2. No
54. I, the undersigned do herby certify the above statements as to residence, income and amount claimed are true and correct. The City of Roeland Park makes every effort to keep recipients names confidential. However , we are unable to guarantee confidentiality due to Kansas Open Records Laws.
56. Electronic Signature Agreement

    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.

    1. I agree.
58. Electronic Signature*
60. OFFICE USE ONLY - Amount of refund awarded. Property Tax:
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field