Maui County Farmer & Rancher Continuity Program Application
Business Legal Name
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Trade Name
*
Farm/Ranch Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Employer Identification Number
Hawaii Tax I.D. Number
*
Farm or Ranch?
*
Primary Contact Name
*
First Name
Last Name
Primary Contact Email (if different than business email)
*
example@example.com
Phone Number (if different than business phone number)
*
Please enter a valid phone number.
Please enter information for the business owner(s)
*
First & Last Name
Ownership %
Phone Number
Email Address
Owner 1
Owner 2
Owner 3
Owner 4
Owner 5
Owner 6
Owner 7
Owner 8
Owner 9
Owner 10
Date Farm/Ranch Established
*
-
Month
-
Day
Year
Date
Number of employees as of March 20, 2020
*
Number of employees as of the date of your application
*
2019 Gross Revenue
*
Select the Amount You Are Requesting: Farmers and Ranchers who made $25,000-$74,999 in 2019 and who showed significant loss in income from 2019-2020 will be considered for a $12,500 expense reimbursement. Farmers and Ranchers who made $75,000 or more in 2019 and who showed significant loss in income from 2019-2020 will be considered for $25,000 expense reimbursement.
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Up to $12,500
Up to $25,000
Please explain how your farm or ranch has been impacted by COVID-19 and your need for this grant.
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Is your home on your farmland?
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Yes
No
What is the acreage of your farm/ranch?
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If your home is on your farm/ranch land, how much of the land is dedicated to the home on the property (in acres)?
In the past year, has the business or a listed owner been convicted of a criminal offense committed during and in connection with a riot or civil disorder or other declared disaster, or ever been engaged in the production of any product or service that has been determined to be obscene by a court of competent jurisdiction?
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Yes
No
Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction?
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Yes
No
For any criminal offense - other than a minor vehicle violation - have you ever been convicted, plead guilty, please nolo contendere, been placed on pretrial diversion, or been placed on any form of parole or probation (including probation before judgement)?
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Yes
No
Have you been arrested in the past 6 months for any criminal offense?
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Yes
No
Please upload your business monthly or quarterly GET forms (G45) for January 2019-September 2019. *You may upload them together as 1 file or as separate documents.
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Please upload your business monthly or quarterly GET forms (G45) for January 2020-September 2020. *You may upload them together as 1 file or as separate documents.
*
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Please upload your 2019 IRS 1040 Schedule F or your corporate tax return for 2019, showing farm profits or loss.
*
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Please upload receipts for qualified expenses between April 1, 2020 - November 20, 2020. Allowable expenses include farmland rent/mortgage, farmland utilities, seeds/plants, fertilizer/pesticide/mulch/compost, equipment and/or vehicle repairs & maintenance, irrigation repairs, planting supplies/tables/containers, fuel, packaging, and feed for livestock.
*
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of
I hereby certify that I did not receive funding assistance from the Kokua Maui County Small Business Recovery & Relief Fund, the Maui County Adaptability Fund and/or the Maui Chamber of Commerce Micro Business Loan Program. I understand that I may simultaneously apply for other State and Federal funding programs, but no expense paid for under this program will be included in other applications. I have the authority to make this certification, and that all of the above information in this application is true and correct.
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