Forms • King George County, VA • CivicEngage

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King George CARES Grant Application

Leave This Blank:

First Name *

Last Name*

Business Name (As it appears on your Business Licenses):*

Business Address:

Email Address:*

Phone Number:*

Is King George County your principal place of business? *

Yes

No

Have you received an Economic Injury Disaster Loan (EIDL) or Paycheck Protection Program funding or any federal assistance in response to the COVID-19 Pandemic? *

Yes

No

With the exception of nonprofits, do you have at least 1 full-time equivalent (FTE) but less than 50 FTEs in one or more locations in King George County?*

Yes

No

Please state how many Part-Time Equivalents and Full-Time Equivalents your businesses or organization had before March 1, 2020? (Example Answer: PTE = 2 FTE = 5)

If you file a VEC Quarterly Payroll Report, please attached the last two quarterly reports.

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Are you a non-profit? *

Yes

No

If you answered "Yes" to the previous question, please attached your most recent 990 forms.

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Do you have a valid Business, Professional, and Occupational Licenses issued prior to March 1, 2019? *

Yes

No

If you answered "Yes" to the previous question, please attach a copy of your BPOL licenses.

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Are you a Sole Proprietor? *

Yes

No

If you answer "Yes" to the previous question, please submit your most recent tax returns, be sure to include your Schedule C or Schedule SE forms.

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Are you currently receiving unemployment benefits? *

Yes

No

Please upload the most recent profit and loss statement or any supporting documentation to show the impact COVID-19 is having on your business?

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Please summarize what the funds will be used for? (Ex: Payroll, Barriers, Cash registers, Outdoor Seating, Rent Utilities, etc..)

Please attach Form W-9 (Tax Payer Identification Number and Certification). This form will be used to process your grant award. *

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* indicates required fields.

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King George County

10459 Courthouse Drive

King George, VA 22485

Phone: 540-775-9181
Fax: 540-775-5248

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