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<br />'. ICATION FOR STATE OR FEDERAL As CE <br />OhlCE OF THE GOVERNOR, CRIMINAL JUSTICE DNlSION <br /> <br />,.- For CJD Use Only <br /> <br />J. a. Dale Submitted <br /> <br />b. Appllcanlldentifier <br /> <br />" <br /> <br />.......,..... <br />2. FedenllSlale Program CI...incatlon (For CJO U.e Only)' <br /> <br />4. a. Date Received by Stale/COG <br /> <br />I b. State Application Identifier <br />I <br /> <br />J <br /> <br />. <br /> <br />5. Applicant Inronnation <br />a. Legal Name: <br /> <br />"..,: <br /> <br />c. Organizalional Unit <br /> <br />b. Address (!I've $treet or P. O. Box, city, ~tato. and zip code) <br /> <br />d. Name, telephone, and tax number 01 the person to be contacled <br />concerning this applicatlon (give area code). <br /> <br />.. .,.:?.:::'~ :;.,:. : 6.~':Slate . Payee'ldentification Number ":;:: .,.:. <br /> <br />.... <br /> <br />7. Typeot Applicanl (ontor tho appropn'at.l.lter in box) <br /> <br />. <br /> <br />8. Type or Application: <br />o New <br /> <br />o <br /> <br />Continuation <br /> <br />A. Shlle <br />O. County <br />C. Moolcipal <br />O. TOM"lsN'p <br />E. Inlenlal. <br />F. Inlennunkip:d <br />G. SpocialDlslrlc:t <br /> <br />H. Independent Schad Di.lrid <br />I. Sial. Conlrolled Institution 01 High.r Learning <br />J. Private Unlven.ity <br />K Indian Tribe <br />L. Indfvtdu:al <br />M. P,lvale Nonpro(lt CofporaUon <br />N. Other (.pecify): <br /> <br />O' <br /> <br />'. <br /> <br />Ir continuation. enter year or runding <br />10. Ir Applicalion for Federal Funds: <br />ChecltCalalog or Federal Domestic Assistance Number. (only one) <br />a 16.S4O-Juvenile Justice & Delinquency Prevention Act <br />o 18.57S-Viclims or Crime Act <br />.0. lG.57~Texas Narcolics Control Program. <br />o lG.580-High Inten.ity Drug TraffICking Program <br /> <br />9. Name or Grantor Agency: <br />Office or the Governor, Criminal Justice DMsJon <br />P. O. Box 12428 <br />Auslin. Texa. 78711 <br /> <br />11. Geographic Area. or Project Acllvitie. (Cities and Coundes) <br /> <br />. <br /> <br />12. TItle of Project <br /> <br />13. Proposed Project: <br />a. Start Dale: <br /> <br />b. Ending Cate: <br /> <br />14. If Application lor State Funds: <br />'~':"Ch~k'~pp~~p;;;i~";~~d':"i~~I;;'~~;'j"""""'"''''''''''''''......!...b:...i;.4.i.i..F.~~d:..~;;;;;;k..;;;;~;.iiY...-i~;;~.~~~)_.................................................._....~~.C;;;;kO~~:--..._. <br /> <br />a 421 Fund ! 0 C.J. Planning 0 Law Enrorcement Training 0 Juvenile <br />o Crime Stoppers Assistance Fund 1 D G <br />o Other Fund i 0 Violenl Crime 0 rug. 0 ang. 0 VlC1lm. 0 Non-juvenlle <br /> <br />15. Requested Funding: 16. 13 application subject to review by stale executive order 12312 proces.s1 <br />a. Federal Granl $ .00 <br />Funds (CJD) <br /> <br />o <br /> <br />YES, this application was provided to the Texa3 Review and Comment System <br />(TRACS) tor review on <br /> <br />.......-...................................................................................................... <br /> <br />b. State Grant <br />Fund. (CJD) <br /> <br />s <br /> <br />.00 <br /> <br />(dale) <br /> <br />c. Cash Malch <br /> <br />s. <br /> <br />.00 <br /> <br />o Program Is not covered by E. O. 11372 <br /> <br />d. In. Kind $ <br />(VOCA &. T.u. v Only) <br /> <br />o Program ha. nol been selected by stale ror review <br /> <br />.......-......................... .......-...-.......................................................... <br /> <br />.00 <br /> <br />17. Is Ihe applicant delinquenl on any federal debt? <br /> <br />................................................................................................................ <br />e. TOTAL S .00 <br /> <br />o <br /> <br />YES Ir "Yes" attach an cxplanaUon <br /> <br />o NO <br /> <br />18. To the best or my knowledge and belief, an data in lhl. application is !rue and correct. The document ha. been duly authorized by !he governing <br />body of the applicant and the applicant will comply with the attached assurances U the assistance Is awarded. < <br />, <br /> <br />a. Typed Name or Authoriled Orncial <br /> <br />b. Tille <br /> <br />c. T elephont Number <br /> <br />d. Slgnalure or Authoriled Orncial <br /> <br />e. Oate Signed <br />