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REQUEST FOR PUBLIC FUNDING <br />Non-profit agencies requesting funding from the City of Paris for projects that benefit the citizens of Paris must complete <br />the following information to be eligible for consideration (you may use additional pages, if necessary). In addition, please <br />submit with this form a copy of your agency's most recent financial statement or audit and a detailed budget for the <br />project. Agencies must also make a brief presentation on their project at a city council meeting. <br />Agency Name: 0, A51-t- -fp 1L K Date: 4 +13' QP <br />Agency Mailing Address: <br />Agency Phone Number: R 0 Agency Fax Number: 7 3~-q:~ 08 <br />~ <br />Contact Person: c.-~ ~ c~- K`J~~-~ ~'uJ/J a (4-S Contact's Title: ( jt J C f~~J t Y'E' cid~-' <br />Contact's Mailing Address: aoo1 I N w o~b ~ ' ~Z~S ~ <br />Contact's Phone Number: ~Q3 - °7 3%- ~-f 31-4 (c Contact's Fax Number: Cf 0?~ 5%-~.S o~ <br />Contact's Email Address: 5~ 1 i: (-0N(T (Z (',a~ S3 " 2K ~ LL c, '0 & 21 <br />Name of Project <br />Location/Service <br />Summary of Pro <br />Describe how your project will benefit the City of Paris and its citizens: QAa CbCdo <br />List other sources of funding for this project and the amounts: wl 0.1 Ooo tr&m ~yt, J t~ <br />Is a detailed project budget, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? [Yes ❑ No <br />Is the agency's most recent financial statement or audit attached? [1/ Yes ❑ No <br />Have you received funding from the City of Paris in the last five years for this or any other project? ❑ Yes E~<o <br />If you have received previous city funding, list the name of the project, the amount of the City's award, and the <br />year awarded: NwardfA S_&M p tSlf'O~. . <br />City of Paris Revised 6/10/08 <br />53 (A) <br />