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Applicant Information

First Name*
Last Name*
Firm
Address1*
Address2
City*
State*
Zip*
Office Phone
Mobile Phone
Email*
Applicant is:*
1. An Individual
2. Corporation
3. Partnership
1. LLC
2. Other (Describe)
Other Description
If a Corporation, Partnership or LLC, indicate the principals and ownership interest:
First Name
Last Name
Title
Interest
Relationship*
Is the applicant or any owner, stockholder, officer or director, or member of their immediate family, an employee, elected official or contractor of the Village of Roselle?
1. Yes (please explain)
2. No
Relationship Explanation
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Please provide address of project.
Address1*
City*
State*
Zip*
Is the applicant*
1. Property Owner
2. Lessee
If Lessee, Owner Approval Will Be Required as a Signatory of this Application)
Current use of the property
Incentive Program Request*
Identify the Incentive Program Application Being Requested
1. Small Business Micro Grant
2. Site Appearance Grant
3. Facade-Exterior Improvement Grant
4. Interior Improvement Grant
5. Strategic Investment Incentive
Grant Guidelines
TIF Incentive Programs page
Consult grant guidelines on the TIF Incentive Programs webpage for eligibility criteria.
Proposed Use of Property Upon Project Completion*
Describe the Project Goal(s) and Identify What Will Be Accomplished *
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Assuming that your application was approved thirty (30) days from the date of this submittal, identify the completion dates of the various project phases.
Plan Preparation & Permit Approval Completion Date*
Plan Preparation & Permit Approval Completion Date
Occupancy/Completion Date*
Occupancy/Completion Date
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Sketches or renderings of proposed improvement.
Landscape plan
Proof of Ownership
Proof of ownership of property, or documentation indicating owner approval of any physical improvements to property.
Strategic Investment Grant (ONLY)
Applications for the Strategic Investment Incentive Grant may be required to provide detailed documentation including a business plan, project pro forma, market study, evidence of financing and other information that will demonstrate the viability of the proposal.
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By signing this request for TIF assistance, applicant agrees to the following:
They are authorized to act as applicant. The information provided is true and correct. They acknowledge that project would not be completed without the use of TIF assistance. Project work is to be performed in accordance with Village codes, requirements of the Tax Increment Financing Incentive Program Guide and terms of the written agreement approving the project. Reimbursement will only occur for work or expenses incurred after the approval of a grant agreement.
Name of Athorized Applicant*
Applicant Signature*
Date of Application*
Date of Application
Name of Property Owner (if applicable)
Owner Signature

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