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Dove Financial Assistance Application <br /> Name: Date of Birth: <br /> Address: City: Zip: <br /> Phone: Email: <br /> Type of Assistance Needed: <br /> ❑ Rent <br /> How much do you owe? What months? <br /> Landlord's name, address, and phone number: <br /> ❑ Power/Gas <br /> How much do you owe? What months? <br /> Ameren/other account number: <br /> ❑ Water <br /> How much do you owe? What months? <br /> City of Decatur/other water bill account number: <br /> ❑ Garbage <br /> How much do you owe? What months? <br /> Garbage Company Name and Address: <br /> Account number: <br />