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<br />\PPLlCATlON FOR STATE OR FEOERAL Ass NCE <br />OFFICE G. ,HE GOVERNOR, AUTOMOBILE THEFT PREV~"nON AUTHORITY <br /> <br />ATPA-1 <br /> <br />1. For ATPA Use Only <br /> <br />3. a. Date Submitted <br /> <br />b. Applicant Identifier <br /> <br />2. Federal/Stet. Program Classification (For ATPA Use Only) <br /> <br />04. ._ Date Received by Stale <br /> <br />b. Slale Application Identifier <br /> <br />5. Applicant Information <br />.. legal Nama: <br /> <br />c. Organizational Unit <br /> <br />b. Address (gNe str...t or P. O. Box. city, county, st.,., .nd zip code) <br /> <br />d. Name and telephone number of the person 10 be contacted on marters <br />involving this application (give area code). <br /> <br />7. Type of Applicant <br /> <br />a. Type of Application: <br />o New 0 Continuation 0 Revision <br />If Revision. check appropriate box{es). <br />o Increase Award 0 Other (specify) <br />o Decrease Award <br />o Increase Duration <br />I 0 Decrease Duration <br /> <br />A. Stale <br />B County <br />C MunICipal <br />o Township <br />E Interstate <br />F IntermunlClpaJ <br />G SpeCial District <br /> <br />(enter the appropriate leNe' in box) D <br /> <br />H Independent SChoo! District <br />I S:ale Controlled InSl~utlon of 1-"9her Learning <br />J Private University <br />K InQlan Tribe <br />L IndIVIdual <br />M Nonprofli OrganIZation <br />N Omer (specify) <br /> <br />6. State Payee Identification Number <br /> <br />9 Name of Grantor Agency: <br /> <br />Automobile Thef'l Pre....ention Authority <br />4000 Jackson Avenue <br />Austin, Texas 78n9~C)1 <br /> <br />10. Titl. of Projec:t: <br /> <br />". Areas of Project Activities (Cities, Counties. St.tes, etc.) <br /> <br />, 2. Proposed Proj~ <br />Start Dale: <br /> <br />13. Is application subject to review by state executive order 12372 process? <br /> <br />Ending Oate: <br /> <br />14. Requested Funding: <br /> <br />o YES, this application was made available to the iexas Review and Comment <br />System (TRACS) for review on <br /> <br />..................................7....................................................................... <br /> <br />(dllte) <br /> <br />a. State Grant <br />Funds (ATPA) <br /> <br />s <br /> <br />,00 <br /> <br />. NO. <br /> <br />o Program is not covered by E. O. 12372 <br /> <br />b. Cash Match <br /> <br />! $ <br />! <br /> <br />00 <br /> <br />. Program has not been selected by state for review <br /> <br />c.ln.Kind <br /> <br />s <br /> <br />.00 <br /> <br />":::-.:.::::::::::::::::::::::::-:'.r.::::'.::.'.:-.:::::::::::::-:-::::-:::::::::::::::::::::::::::-:::::::::::.. <br /> <br />15. Is the applieant delinquent on any federal debt? <br /> <br />d. TOTAL <br /> <br />; <br /> <br />! S <br /> <br /> <br />16. To the best of my knowledge and belief. all data in this application is true and correct. The document has mn duty authorized by the governing <br />body of the appliellnt and the applicant will comply with the anach~ assurances if the assistance is awarded. <br /> <br />.00 <br /> <br />DYES <br /> <br />If .Ves. anach an exptanation <br /> <br />o <br /> <br />NO <br /> <br />a. Typed Name of Authorized otIicial <br /> <br />lb. Title r. Telephone Number <br />; , <br />.................__........._.1.._........._....._.............._................_..._.....!..___.........._._........................................ <br />Ie. Date Signed <br /> <br />d. Signature of Authorized Official <br />