34.3.104    APPLICATION FOR ASSISTANCE

(1) If the total estimated expenditures necessary to respond to the emergency are greater than the estimated resources available for the emergency, the board or council may request the governor to declare an emergency and to initiate action to provide state financial assistance in accordance with such declaration. The application should be made on the following form: The Honorable Ted Schwinden

Governor of Montana

State Capitol

Helena, Montana 59620

 

Dear Governor Schwinden:

 

Pursuant to our authority as__________________________________________________ 

of________________________________________________, Montana, we request that an emergency be declared immediately to provide supplemental disaster relief in accordance with the provisions of Title 10, chapter 3, part 3, MCA.

 

1.    SITUATION

           A. (Date and description of conditions causing

                  disaster)

 

 

 

           B.    (Description of damages to public sector)

 

 

 

           C. (Description of damages to private sector)

 

 

 

           D. (Description of economic impact)

 

 

 

2.    OFFICIAL ACTION

 

           A.    The County Disaster Committee has determined by

                 a majority vote that an emergency does exist.

                 Attached is a copy of the signed resolution.

 

           B.    This __________________________has levied the

                 emergency two mill levy authorized by Section

                 10-3-405, MCA. (Attach copy of resolution

                 imposing the levy.)

 

           C. (Other action taken)

3.    DAMAGE ESTIMATES

 

 

          A.   Debris Clearance                                                                      $                                

 

          B.   Protective Measures                                                                                                   

 

          C.   Road Systems                                                                                                             

 

 

          D.   Water Control Facilities                                                                                              

                                                           

          E.   Public Buildings and Related

               Equipment                                                                                                                      

 

          F.   Public Utilities                                                                                                               

 

          G.   Public Facilities Under

               Construction

 

          H.   Other Damages (Not in Above

               Categories)                                                                                                                    

 

              TOTAL ESTIMATED DAMAGES                                                 $                             

 

4.    LOCAL RESOURCES

 

       Names of funds or accounts involved:                                                                                  

 

                                                                                                                                                          

 

                                                                                                                                                          

 

 

 

ESTIMATED

 

       Cash balance including reserves as of

         June 30, 19                                                                                        $                                 

 

       Receipts from two mill emergency levy                                                                                

 

       Receipts from maximum permissive levy

         and other anticipated revenues                                                                                           

 

             SUB TOTAL                                                                                   $                                 

        Less regular operating budget including

        reserve budgeted for year per Sec.

        7-6-2319, MCA.                                                                                                                     

 

          BALANCE AVAILABLE TO RESPOND TO

            EMERGENCY                                                                                 $                                 

 

5.    ASSISTANCE REQUIRED

 

       Total damage estimate (from No. 3)                                                  $                                 

 

       Less estimated resources available

       from No. 4)                                                                                                                               

 

          ESTIMATED ASSISTANCE REQUIRED                                      $                                 

 

Date                        

                                                                                                                                                           

                                                                                           (Title of Board or Council)

                                                                                            By:                                                         

                                                                                                                       Chairman

                                                                                                                                                           

                                                                                                                       Member

                                                                                                                                                           

                                                                                                                       Member

 

History: Sec. 10-3-311 MCA; IMP, 10-3-311 MCA; NEW, 1978 MAR p. 716, Eff. 5/26/78; TRANS, from Dept of Admin. , Ch. 111, L. 1985, Eff. 10/1/85.