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<br />,",PPLlCATlON FOR STATE OR FEDERAL ASSISTANCE <br />OFFICE OF THE GOVERNOR, CRIMINAL JUSTICE DIVISION <br /> <br />1. ForCJDUseOnly <br /> <br />3. a. Date Submitted <br /> <br />b. Applicant Identifier <br /> <br />2. FederallState Program Classification (For CJD Use Only) <br /> <br />4. a. Date Received by State/COG <br /> <br />b. State Application Identifier <br /> <br />5. Applicant Information <br /> <br />.......~.......__.__.__....w...__.______........._._..........___._.............................__......._____.........__._...._...._......_._............................._.._..................... <br />a. Leoal Name: I c. Oroanizational Unn <br /> <br />b. Address (give street or P. O. Box, city, st.te, and zip code) <br /> <br />id. <br />I <br />, <br />1 <br /> <br />Name, telephone, and fax number of the person to be contacted <br />conceming this applieation (give area code). <br /> <br />6. State Payee Identification Number <br /> <br />7. Type of Applicant (enter the approprilJte letter in box) <br /> <br />8. Type of Application: <br />a New <br /> <br />D <br /> <br />Continuation <br /> <br />A. Stlte <br />B. County <br />C. Municipal <br />O. Town5hip <br />E. Interstate <br />F. Irtermunicipel <br />G. SpeciIIlOiltriet <br /> <br />H. Independent School District <br />1. State Controlled Institution of Higher learning <br />J. F>rivate University <br />K Indian Tribe <br />L IndMdual <br />M. Nonprofit Organization <br />N. Other (Specify): <br /> <br />o <br /> <br />If continuation. enter year of funding <br />10. Applicationlor. <br />Federal Safe and Drug.Free Schools and Communities Fund <br /> <br />9. Name of Grantor Agency: <br />Offtce of the Governor, CriminaJ Justice otvision <br />P. O. Be. 12428 <br />Austin, Texas 78711 <br />". Geographic Area. 01 Project Aelivni.. (Citi.. and Counties) <br /> <br />12. 11lIe 01 Project: <br /> <br />13. Proposed Project: <br />-~~.sj;rt-lii~~.h._..__.__.h_............Tb.-~i~g..o;;;;....................h................. <br /> <br />14. II Application lor State Funds: <br />a. Checkappropriatelund: (only one) <br />Q 421 Fund <br />Q Crime Stoppers Assistance Fund <br />D othor Fund <br />15. Requested Funding: <br />a. Federal Grant $ <br />Fund. (CJD) <br /> <br />. b. 11421 Fund.~kpriority. (only one) <br /> <br />o C.J. P1aMlng Q Law EnloroemenlT_lnl1 <br />o VIOlent Crime Q Drug. 0 Gang. 0 Victims <br /> <br />c. Check One: <br />Q Juvenile <br />Q Non-:iuvenile <br /> <br />.00 <br /> <br />16. Is application subject to review by state executtve order 12372 process? <br /> <br />b. Slate Grant <br />Fund. (CJD) <br /> <br />::J YES, this appiication was provided to the Texas Review and Comment System <br />(TRACS) for review on <br /> <br />s <br /> <br />.00 <br /> <br />(dale) <br /> <br />c. Cash Match <br /> <br />s <br /> <br />.00 <br /> <br />u Program is not covered by E. O. 12372 <br /> <br />d. In-Kind $ <br />(VOCA' illIt V Oniy) <br /> <br />..:.TOTAi:..........nT.s..n........n..................n...........:OO.... <br /> <br />I <br /> <br />Q Program has not been selected by state for review <br /> <br />.00 <br /> <br />17. Is the applicant delinquent on any federal debt? <br /> <br />::J YES If "'Yes" attach an explanation <br /> <br />:J <br /> <br />NO <br /> <br />18. To the best of my knOYlledge and belief. all data in this application is true and correct. The document has been duly authorized by the governing <br />body of the applicant and the applicant will compty with the attached assurances if the assistanee is awarded. <br /> <br />a. Typed Name of Authorized Official <br />Hichael E, Halone <br /> <br />j b. Iltle ! c. Telephone Number <br />I City Hanager !(903) 785-7511 <br />..................................................................................................-.............................................-......................................................r................................................................ <br />d. Signature of Authorized Official ! e. Date Signed <br />I <br />, <br />, <br />I <br />, <br /> <br />eJD-! <br />EXHIBIT A <br /> <br />Issued 10/94 <br />