|
<br />>:.~~~~ ~~~,.'
<br />, .....,...-..-.----.-,...-..-.'--...-
<br />,,~J..>.~:,,',.j.: ; '" ,;,;-,... "...~~;.', ~.
<br />
<br />";a.~~J't~~.);,'_",f_~~Wl'~~~,1'<:;;.M..;;'~_~~.,!~:",,.--.JIl~~.:;;.C'
<br />. _: \-- , :"...-:;~~F:\ ;': ':'~-::(':.-:,:~':!:;~-;,~.':', ~~:;~;?:;-:;.::,:,';..!:??'x': r:'>,~~t:,.-:;,/,::~'
<br />
<br />
<br />~~~~:'T~
<br />
<br />LOCAL LAW ENFORCEMENT BLOCK GRANTS PROGRAM
<br />LOCAT ~PPLICATION FORM
<br />
<br />
<br />C205
<br />
<br />City of Paris
<br />
<br />'. """'Y''''r,.'ticJ::-''1\;:Ii.~-4-j...J ",'-
<br />tt'l '-)~t 'J,1~i::,:,~\&::~~~:;:-l~~tH
<br />~,._. .' _'W\t'~.
<br />
<br />'",'41
<br />
<br />""''"'_~'~' ',"_."..",~ ~~.<M'7'"
<br />,.. t hI- "__')\~',t""',,;.J:_.,,, ~~j~
<br />~~". :', no>:; . _;;t./>o.~.,'"';P" ;y . __ C" 4:Vf,l~;..
<br />
<br />
<br />~"
<br />-<,.--"~-
<br />
<br />
<br />to ..
<br />
<br />'~l
<br />.. ,..'.,:_,;.:,:,\,,':.iii..~<;~"'~'i:;1~~S.1"1.w:ri'o;~'tf~..;~"'.ni"ti,;,~_:;,.",,,':"I'i . "C, j 1i.',j"'ti
<br />":;'T1:LJ.~~~!:.il.\.; ~.i~-m."'~!'?G:'_~("-::?;-.?ff:; >,::~~h'h,~~_
<br />
<br />.
<br />
<br />::o;....:..-"..-,..i',...,.,...-""...."."~,, .~.'..".~,.....",:..:,,: ''1;.',' ,"Jfo-.V"'~'k .' .. '.i:1;"~~~'\"""'.t':
<br />.. ~.p.~' '''_'~ r,~''''''''_'''-.1O-.":.....;...,~,";,,,:_,~:.r-.r<l'....~.:;I_''l'I''''' '(y' "'1;j\~".t~;" . fc:~;t;~
<br />..,,;J.;.;.L~:~.:y,,;t !....,'(; ~ .'~::.Ll.\.:~:.::,,~;.:i.~,'-;-..lo"~>lt3~WSS~.l.:.~~-
<br />
<br />;';;\J.'
<br />
<br />..~
<br />
<br />Your signature repre'enls your legal binding acceplance of the terms of this application and your statement of the veracity of the
<br />representations made in this application. The document has been duly authorized by the governing body of the applicant and the
<br />applicant will comply with the three atlached forms: I) Assurances; 2) Certifications Regarding Lobbying; Debarment, Suspensum and
<br />Other Responsibility Maners; and Drug-Free Workplace Requirements; and 3)Certification Regarding Public Safety Officer Hea/lh Benefits.
<br />~?~(.ll; _~.~~.. ~,~ ~~~':._........,....1. '" '
<br />'" ,.~.... '-'$e'"", .-:;,: ",." '\" ^" , ~ .,
<br />~'t'.i.;t'A~';" at::~~~~~.;,..:~~
<br />
<br />
<br />"",,,,,~", ".,.h_."".~
<br />~~~)':~'l.."Y-:'! \, I>,:.:~,,::;~~
<br />
<br />~~.:~,_~~__-&-~~~~~~~'::..::~'1"m~~~--~1I<J 1"'C'~iiliZ:::t. -<.:t".
<br />CONTACT ADDRESS (IF DIFFEREJ\'T FROM ABOVE):
<br />
<br />EXHUllI A
<br />
|