islamic center of the east valley zakat application form · section 4: zakat request case...
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![Page 1: Islamic Center of the East Valley Zakat Application Form · Section 4: Zakat Request Case Description Please briefly describe your case and need for zakat Islamic Center of the East](https://reader034.vdocument.in/reader034/viewer/2022042416/5f320b75c2532d6e2d375ab2/html5/thumbnails/1.jpg)
425N.AlmaSchoolRd.ChandlerAZ85224|Phone:(480)442-7783|[email protected]
1.Pleasecompletebothsidesofthisform2.Makesureyoureadandcompleteeachsectioncarefullyandthensignattheendoftheform3.AttachacopyofthefrontsideofyourID/License4.Attachsupportingdocumentssuchaspastduebillnotices,evictionnoticesetc.
FullNameFirst Middle Last
Street Apartment#
City State ZipCode
Phone/EmailPhone# Emailaddress
GovernmentIssuedID IDnumber Expirationdate DateofBirth
SpouseNameFirst Middle Last
Numberofchildren Listages
Otherdependentsinhousehold
EmploymentStatusEmployed: Yes No Employmentstatus: FullTime PartTime
Total
AssistancefromotherMasajid
MonthlyIncome(Listpercategory)
IncomeSource Amount
Salary
FoodStamps
GovernmentAssistance
Other
Section3:Employment&Income
Section1:PersonalInformation
Address
FormInstructions
Section2:Family&Dependents
Children&OtherDependents
IslamicCenteroftheEastValleyZakatApplicationForm
Complete nextpage
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![Page 2: Islamic Center of the East Valley Zakat Application Form · Section 4: Zakat Request Case Description Please briefly describe your case and need for zakat Islamic Center of the East](https://reader034.vdocument.in/reader034/viewer/2022042416/5f320b75c2532d6e2d375ab2/html5/thumbnails/2.jpg)
425N.AlmaSchoolRd.ChandlerAZ85224|Phone:(480)442-7783|[email protected]
Approval(ICEVUseOnly)
Referencepersonforcase Name ContactNumber Relationship
PLEASEREADCAREFULLYBEFOREYOUSIGN1.Iconfirmthattheinformationprovidedaboveiscorrectandaccuratetothebestofmyknowledge2.IunderstandthatICEVZakatfundsarelimitedandisdistributedbasedonneedpriority3.IunderstandthatIcanonlyapplyforZakatassistancefromICEVamaximumofonceperquarter(3months)4.IunderstandthatImustalsosupplementthisapplicationwithacopyofmyIDaswellascasesupportingdocuments5.IunderstandthatICEVmaysharemyapplicationinformationwithotherMasajid/OrganizationsZakatDirectors6.Onceapplicationandallnecessarysupportingdocumentsarereceived,youwillbecontactedbytheICEVZakatAdmintogooveryourapplication,thenitwillbesubmittedforfinalapproval/processing.Thisprocessusuallytakes3-5days.
Name Signature Date
Section5:AcknowledgmentandSignature
Section6:FormSubmission
Amount
RequestDetails
Category
PastDueRent
PastDueUtilityBills
MedicalExpenses
Food/Drink/Misc.Expenses
Other(specify)
Total
Section4:ZakatRequest
CaseDescriptionPleasebrieflydescribeyourcaseandneedfor
zakat
IslamicCenteroftheEastValleyZakatApplicationForm
ApplicationscanbesubmittedattheICEVsuggestionboxinthelobbyorbyemailingaclearscannedcopytotheemailaddressinthefooterbelow.
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