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<br />APPLICATION FOR <br />FEDERAL ASSISTANCE <br /> <br />OMS Approval No. O)"'~O"3 <br /> <br />2. DATI SUIMlTTID . <br /> <br />AOO' <br /> <br />Ident,".' <br /> <br />I. TVH OP' SUIMtUM)tt: <br />ADpI#callon <br />o Construction <br /> <br />o Non-con'truelion <br /> <br />PreappJic.tion <br />o ConstrucltOn <br /> <br />: 0 Non-Q>nttrucllon <br /> <br />I. DAn AI!CI~D IV STAT! SI,te Application Idenlif.., <br /> <br />--'--- <br /> <br />4. DATI R'CaIVED IY 'EDIAAL AQI!HC't' Feder'l Idenlih... <br /> <br />,. ."UCANf IN'ORMAnON <br />LlIQal Name: <br /> <br />O,g.n1lltional Unit <br /> <br />-- <br />.-.-- <br />__,__J <br /> <br />Address (gIve CIty, county, stale, and lip cOde): <br /> <br />Name.nd (elephone numbef of the pelson 10 be conla<:led on matlllr.. 1r.'If):"",~ <br />thIS apphc.hon (give ..,... code) <br /> <br />P.O. Box 12428, <br /> <br />I <br />-_.._---~ <br />I <br />i <br />I <br />I <br />j <br />, <br />I <br />I <br />Governor's Office .----1 <br />Criminal Justice Divis'ion <br />Austin. Texas 78711 <br /> <br />o <br /> <br />.. EMPLOYER IOENTIFICAnOH NUMBER !EUI!jI: <br /> <br />o New <br /> <br />o Continuation <br /> <br />o Revision <br /> <br />1. TVPE all' APPLICANT: (enter .tJProprillte lette' in. box, <br />A. Stale H. lndepend9nt School Oist. <br />B. County I. Slate Controlled Instllution of Higher l.M' "';"'J <br />C. Municipal J. Private UnNer5ity <br />D. Township K. Indian Tribe <br />E. Intentate L. Individual <br />F. Intermunicipal M Profit Organization <br />Q. Special Oi:llrict N. Other (Specify): <br /> <br />I. TYPE OF AP'LICA TlOH: <br /> <br />If Revision. enler appropriate lelter(s) in bolll(85): 0 0 <br />A fnc,ease Award B. Decrease Award C. lncreue Duration <br />O. Decrease Duralion Olher (st><<d'i): <br /> <br />I. HAME Of flEDERAL AaI!HCY: <br /> <br />lG. CATALOO 0' 'EOI!RAL OOMEST1C <br />ASSIST ANel! HUMBER: <br /> <br />I <br /> <br />I <br /> <br />1.1 <br /> <br />I <br /> <br />T <br /> <br />t 1. OESCRIPTlYE nTLE 0' APPLlCANT'S PROJECT: <br /> <br />TlTlE, <br /> <br />12. AREAS AFFECTED 8Y PROJECT (cUies. counti.,. st.t.s. .'c.J: <br /> <br />12. PROPOSED PROJECT: <br /> <br />Slarf Dale <br /> <br />Ending Oal8 <br /> <br />104. CONQRI!SSIONAL DISTAICTS OF: <br />a. Applicant <br /> <br />~ b Project <br /> <br />: <br /> <br />15. ESTIMATED FUNDINQ: <br />. Fede,al I <br />b. Applicant I <br />C Slate I <br />d Local I <br />e Other I <br />I PrOQtam Incom. I <br />Q TOTAL I <br /> <br />.00 <br /> <br />11.1$ A"L.ICAnON SUIJECT TO REVIEW B'i STATE EXECUnvE ORDER 12312 PROCESS? <br /> <br />8. YES. TI-lIS PREAPPLICATIONlAF>PlICATlON WAS MAOE AVAILABLE TO THE <br />STATE EXECUnVE ORDER 12372 PROCESS FOR REVIEW ON' <br /> <br />.00 <br /> <br />DATE <br /> <br />.00 <br /> <br />b NO. 0 PROGRAM IS NOT COVERED BY E.D. 12372 <br /> <br />.00 <br /> <br />o OR PROGRA.... HAS NOT BEEN SELECTED BY STATE FOR REVIEW <br /> <br />.00 <br /> <br />.00 17. IS TWE APPLICANT DELINQUENT ON ANY FEDERAL DEBn <br /> <br />,00 <br /> <br />o Y.. <br /> <br />II .Yes.. allach an ell plana Iron. <br /> <br />o No <br /> <br />II. ro THE BEST 0' MY KNOWlEOOE AND BEl.II'. ALL DArA IN THIS APPLICAnONiPAIAPPlICAnOH ARE TAVE AND CORRECT. THE DOCUMENT HAS BEEN DUL.Y <br />AUTHOAIl'fD BY THE GOYERNINO 10DY 0' THE APPLICANT AND THE APPLICANT WILl COMPLY WITH THE ATTACMED ASSURANCES IF THE ASSISTANCE IS AWARDED <br /> <br />a. TvPed Name 01 Aulhor'oI:ed RepresenloJllYe <br /> <br />b Tirle <br /> <br />c Telephone nurnoer <br /> <br />d SiQnJltur. 01 AUlhorlo1:ed Represenlal,,,. <br /> <br />e Dale 'i'lJned <br /> <br />EXHIBIT A <br /> <br />CJD-l <br /> <br />I <br />:::alandard orm J24 ~v J.1l8. <br />Presctlbed Oy OMS \..".....1. 4. h;.! <br /> <br />PreviOUS I:Oll1ons NOI Usable <br />