1994-159-RES WHEREAS, TEXAS SURPLUS PROPERTY AGENCY WAS ABOLISHED BY THE TEXAS LEGISLATURE

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SECTION I: SECTION II: SECTION III: SECTION IV: SECTION V: SECTION VI: SECTION VII: SECTION VIII: ",TE: INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR ELIGIBILITY FORM (Please type or pnnt in blue or biack ink oniy) Provide the full legal name of your organization on the first line of this section" Provide the mailing address of your organization as recognized by the U.S, PosIal Service. Include Zip Code, ProVide the street address If different form mailing address. or provide directions If 10caIed on a rural route or other remote area, list the county in which the organization IS actually 10caIed and a business telephone number wIth area code, Check the appropnate box which descnbes your organization, {If you are unaole to oetermlne which status to check. please contact this office for assistance. I Check the appropriate box or boxes (check as many as apply) WhIch indicates the type or ourpose of your organi- zation. (Definitions have been proVided on the reverse side ot the application to aSSist in making this determina- tion.) Check the appropriate box which indicates the organlzatrons sources of funding. Suoportrng documentation indi- cating the types and amounts of funding must be suomltted with the completed application. ApplicanIs making application as "Nonorofit. tax-exempt organization"' are reqUIred to suomit eVidence that the applicant IS currently aoproved. accreditee. or licensed. Programs for older mdividuals must include eVidence of funding under the Older Americans Act of 1965: Titles IV of XX of the SOCial Security Act: Titles VIII of X of the eCOnOmiC Development Act of 1964: or the Community Service BlOCK Grant Act. PrOViders of assistance to home- less Individuals must Include a letter from the mayor. county Judge. or county health officer or comparable authonty which certifies that aoplicant is a "provider of assistance to the homeless.'. The CertIfication must identify the selVlces or assistance oeing prOVided ana the numoer of individuals receiving such assistance. A comorehenslve written descnption of aU programs or services proVided is reqUired. A deSCription of the opera- tionai faCilities shOUld also be included. Be sure to Include InformaIlon of staff and staff qualifications. hours of operation services and programs offered. population or enrollment. fees charged etc.. Include samples of pam- phlets, catalogs. brochures or posters, If inco'1loration With all filing certificates and amendments. and a copy of your current By-Laws. All applicants making application as "Nonprofit. tax-exempI organizations" must provided a cooy of the IRS deter- mination letter indicaIing tax exemption under Section 501 of the I.R.S. Code of 1954, The name of the organiza- tion on this IRS letter must maIch the name provided in Section I of this application. If not. Include sufficient eVidence such as amendments to Articles of Incorporation. or Assumed Name filing certificates to establish an "audit trail" of names shoeing the legal connection, Annotate date and oravlde an onginaJ signature of applicant's Authorized Official (Presloent. Chairman of the Board. County Judge, Mayer. City Manager. ExecuIive Director. AdministraIor. Fire cnief, or other comparaOle authOrized official.) PhotocopIes. rubber stamped. machine produced. cartlon. or other faCSimile type signatures are not acceptable. Also, pnntlhe name of authOrized officiat on the line proVided. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. USE THIS INSTRUCTION SHEET AS YOUR CHECK L1STTO ASSURETHAT ALL REQUIRED INFORMATION AND DOCUMENTATION IS PROVIDED. IFYOU HAVE A QUESTION OR NEED ASSISTANCE CALL: 512/463.{)493. 5121463-8902. 512/463-5286. .. 03.3o.t:10402 (8JI4)