Caring Breaths Radon Mitigation Expenses Application Form 1. Contact Information First Name Last Name Phone Number Email Street Address City Postal Code State/Province - None - 2. Radon Mitigation Expense Receipts Attach a copy of the receipt you are requesting financial reimbursement for. Maximum 5 files.2 GB limit.Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. 3. Income Verification What is your net disposable income? (monthly income after taxes) Choose range that applies to you. $500 or less $500 - $1000 $1000+ 4. Other Financial Support Select any other organizations you have received financial support from to help cover related costs. Lungs Matter - www.lung.ca (Radon Reduction) Government of Saskatchewan’s Home Renovations Tax Credit - www.saskatchewan.ca Other… Enter other… 6. Did you or your certified radon mitigator test your home pre-mitigation? yes no 7. Where did you get your radon test from? 8. What kind of radon test was used? testwhatoptions Long Term Alpha Track detector E-Perm Continuous Radon Monitor Other (please specify) Enter other… 9. What was the radon level in your home pre-mitigation? radonleveloptions Under 200 Bq/m3 200 Bq/m3-400 Bq/m3 600 Bq/m3 + Optional: Other Information You may use this field to provide any other information you feel is relevant or important to your application. To find out more visit Caringbreaths.ca or If you have any questions about our Caring Breaths program, please email caringbreaths@lungsask.ca Leave this field blank
