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Request for Tree Injection Reimbursement

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Reimbursements are available for treatments against Dutch elm disease, oak wilt and two-lined chestnut borer. Complete the form below to request a 50% base reimbursement or a 75% reimbursement if you are income-qualified.

The first treatment needs to be dated Jan. 1, 2024, or later in order to qualify.

Please correct the fields below:

Name
 *
Name
Address
 *
Address
Phone number
 *
Email
Number of trees treated
 *
Diameter of tree(s) injected (in inches)
Location of tree(s) treated
 *
Location of tree(s) treated
Name of the contractor/company that treated your tree(s)
 *
Date the tree(s) were treated
 *
How long did the contractor/company guarantee the treatment will be good for?
Note: Treatment must be guaranteed for three years for Dutch elm disease and two years for oak wilt and two-lined chestnut borer to qualify.
Total injection cost
 *

Income-qualified property owners are required to self-certify that they qualify. Applicants must have adjusted gross income (AGI) equal to or below 80% of the area median income (AMI), adjusted for household size, as determined by the Federal Department of Housing and Urban Development. AGI can be found on your most recently filed federal income tax return.

Refer to the following chart to determine eligibility for elm and oak tree treatment reimbursements at the 75% rate.

Number of people in household 80% area median income
1 $68,500
2 $78,250
3 $88,050
4 $97,800
5 $105,650
6 $113,450
7 $121,300
8 $129,100
Do you qualify for the higher 75% reimbursement rate for income-qualified residents?
 *
Do you qualify for the higher 75% reimbursement rate for income-qualified residents?

Attachments

In your submission, you will need to provide the city with a copy of the invoice, proof of payment and a W-9.

Copy of invoice
 *
Proof of payment
 *

W-9 form

Complete and upload a W-9 form.

 *

Signature

By typing your name below, you certify that the information provided in this application is accurate.

Signature
 *
  1. To receive a copy of your submission, please fill out your email address below and submit.