Funded by the Margaret T. Petrie Spaying and Neutering Foundation

through CARE’s Lillie’s Fund

Offer Ends May 31

3for FREEfemales ONLY

I understand that Lillie’s Fund is for pets owned by me—the applicant. Information I have provided about myself, my pets and income is accurate and truthful. I have enclosed a copy of my Medicaid or Food Stamps card, or the best proof I have of my household income from all sources. Fraudulent use of Lillie’s Fund will result in services charged to me at full price and possible legal action against me and others involved in the fraudulent use of vouchers.

Name: Street Address:

Where did you hear about us/CARE? City and Zipcode:

Mailing Address:(if different) City and Zipcode: Daytime Phone: Evening Phone: Email Address: Your Age: Number of Adults in Your Household: Number of Children in Your Household:

Important Note About Privacy: The information you provide will be used only for determining eligibility and will not be used for any other purposes. For additional protection of your private information, please mark through the Social Security or Medicaid numbers on all copies of documents.

What Photocopied Documents Are You Enclosing With Your Application For Proof of Eligibility? Adult Medicaid CardFood Stamps CardCopy of Page 1 of Income Tax Return for Each Adult in Your Household (only needed if you don’t have Medicaid or Food Stamps card.)

What is Your Current Annual HOUSEHOLD Income From All Sources (before taxes)? __________________________

Note about income: If you think you qualify based on your current income, but did not file taxes, your income has decreased since your last income tax return, are unemployed or prefer not to send your tax return, please enclose a letter of explanation and your best proof of eligibility (W-2, check stubs, etc.)

Identify Your Pets That Need Spay/Neuter Surgery* Dog/Cat Name Sex

M or F Description/Breed In Heat or Pregnant Age* Weight CARE Use Only

*Please specify age for kittens or puppies 4 months or younger.

Signature: ___________________________________________________ Date: ______________________________

Office Use Only Date: Check/Cash: Comments:

CCAARREE’’SS LLIILLLLIIEE’’SS FFUUNNDD A Financial Assistance Program for Pet Spay/Neuter

your petFIX

Special Offer

NOCo-pay!

Paid for by

Lillie’s Fundchathamanimalrescue.org

919.542.5757

(Español al otro lado)

Do I Qualify For CARE’s Lillie’s Fund?To qualify for Lillie’s Fund you must be a Chatham County resident and have an annual household income of $40,000 or less. Include a copy of page 1 of your 1040 tax return for the previous year.

For additional ways to qualify, see the list on the application and check the one that applies.

How do I use Lillie’s Fund?Complete this application and send to:

CARE PO Box 555 Pittsboro, NC 27312

Include a $20 co-pay. Cash, check ormoney order is okay. Kittens and puppies

will also receive a list of participating vets. Call for an appointment as soon as possible. Vouchers are good for only 2 months from the date of issue.

Also include a copy of any letter, W-2,check stub, etc. to prove you qualify.

After processing your request, we will

f participating veterinarians. Call the eterinarian you choose as soon as possible

Financial information about this organization and a copy of its license are available from the State Solicitation Licensing Branch at 919-807-2000.

spay FEMALE pets FREE3 pets per household

Offer ends March 31, 2014

Do I Qualify For CARE’s Lillie’s Fund?To qualify for Lillie’s Fund you must be a Chatham County resident and have an annual household income of $40,000 or less. Include a copy of page 1 of your

1040 tax return for the previous year.

For additional ways to qualify, see the list on the application and check the one that applies.

How do I use Lillie’s Fund?Complete this application and send to:

CAREPO Box 610Pittsboro, NC 27312

1.

2. When you receive your vouchers, you willalso receive a list of participating vets. Call for an appointment as soon as possible. Vouch-ers are good for only 2 months from the date of issue.

3. Also include a copy of any letter, W-2, checkstub, etc. to prove you qualify.

you your voucher(s) and the list of participat-ing veterinarians. Call the veterinarian youchoose as soon as possible.

Financial information about this organization and a copy of its license are available from the

State Solicitation Licensing Branch at 919-807-2000. This license is not an endorsement by the State.

FEMALES onlyFREE

3 pets per householdoffer expires May 31

FIXyour petSpecial Offer

* 3 FREE *No Copay!

chathamanimalrescue.org chathamrescate.org

919.542.5757

Paid for byLillie’s Fund

(Español al otro lado)

After processing your request, we will send

If Mom is spayed, her kittens or puppies only require a $5 copay each if they are under 4 months old.

Pregnant cats and dogs can be spayed. Tell your veterinarian if you believe your pet is pregnant.

*Please specify age for kittens or puppies 4 months or younger.

Chatham Animal Rescue & Education

chathamanimalrescue.orgchathamrescate.org

919.542.5757

(Espãnol al otro lado)

Do I Qualify For CARE’s Lillie’s Fund?

To qualify for Lillie’s Fund you must be a Chatham County resident and have an annual household income of $40,000 or less.

You will be asked to provide documentation to verify your eligibility. More information about typically acceptable documentation can be found on the application form.

Financial information about this organization and a copy of its license are available from the State Solicitation

Licensing Branch at 919-807-2000. This license is not an endorsement by the State.

How do I use Lillie’s Fund?Complete this application and send to:

CAREPO Box 610Pittsboro, NC 27312

1. Also include a copy of any letter, W-2 form, check, paystub, page 1 from tax return, etc. to prove you are eligible.

2. Pregnant cats and dogs can be spayed. Tell the veterinarian if you believe your pet is pregnant.

FEMALE pet

FIXYOUR