HomeMy WebLinkAboutFinancial_Assistance_Application_20200811.doc
FINANCIAL ASSISTANCE APPLICATION
Tax ID: 364519083
The mission of SLO LEAF is to provide immediate and temporary financial assistance to San Luis Obispo
County law enforcement personnel and their immediate families, who are currently employed or honorably
retired and who are experiencing a catastrophic financial need due to; serious injury, critical illness or at time
of death.
Instructions
1. Requesting employee should complete all sections of this form including signatures.
2. Email/mail application form, all pertinent copies of invoices, bills, receipts and credit card statements to SLO LEAF
at the address below.
IF APPROVED, PAYMENT WILL BE MADE DIRECTLY TO CREDITORS
Employee Information (Please Print)
Employee Name:
Luca Benedetti
Employee Agency:
San Luis Obispo PD
Requesting assistance for:
○ Self ▢ Immediate Family Member
Name: Rick Scott Relationship:Employer Age:N/A
Home Mailing Address:
1042 Walnut St.
State:
CA Zip:
93401
Mobile Phone:
(
Work Phone:
( 805 ) 781 - 7256
Home Phone:
(
Home Email:
rscott@slocity.org
Explain your request for funding (Attach paper if more room is needed)
The community and Police Department of San Luis Obispo lost an amazing police officer in
Luca Benedetti when he was tragically shot and killed in the line of duty on May 10, 2021.
There is no department budget to fund expenses related to his death for either the department
or his family. This request will help cover expenses for department members to witness his
enrollment in the state police officer's memorial at $2680 and for his wife and kids to witness his
enrollment in the national police officer's memorial at $2735 f or a total of $5415.
Total amount requested on this application: $ $5415.00
Type of assistance requested: ▢ Direct (Bill pay to creditors) ▢ 501c(3) Fiduciary (For your fundraising activity)
Do you plan to request additional funds? ▢ No ▢ Yes ▢ Unknown at this time
I do hearby certify all the information to be correct and true.
REQUESTING EMPLOYEE SIGNATURE: DATE:
(Agency Use Only)
D.A.
Sheriff
Chief of Police
Dept.Head
Rick Scott - Chief of Police
4/4/2022
Print Name Signature Date
Revised 08-11-20/dj
SLO LEAF
P.O. Box 13126
San Luis Obispo, CA 93406
www.sloleaf.org
Contact CJ Hunt with questions I 805.801.4616 I sloleaf@gmail.com