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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: L- a&, a✓. ~rrt-~ u Date: -e <br />Agency Mailing Address:~ Agency Phone Number: s, Agency Fax Number: <br />Contact Person:~ .~6 Contact's Title:~,~ <br />Contact's Mailing Address: cl ( t ,e V,~~ <br />~ i <br />Contact's Phone Number: (.~I Contact's Fax Number: ~4 7-.IJ <br />Cnntact's Fmail Address; Name of Project: <br />e - • • ~ ~ . . . . . ^ <br />Location/Service Area of Project:~~ 3-t _ k-7~~~~" 1- <br />~ • " , <br />~i <br />Summary of Project:~ 4~ 5 LitVi i1'F vFi al <br /> <br />i~', r'~~' <br />Y~ t~h id lr g a r". <br />t , ~ ~ ~`ltce ~fa ~-j~• ~-y'~ ; d- 1 r'r"t < ._~~`t~~li "~I•7 ' <br />~ . ~ • r. <br />LC <br />J A 1 1 vi <br />~4'~~ 1~- ~iA l•~t" I~.tzlt'Y''.i"Se IUL~~d <br />, <br />. ~ J <br />1 <br />au, +I r~t,~ j~,r i~c. <br />. . , . ti <br />, <br />C, t• `i" C' ~t~ `j. 'LrsAV <br />, . . . -t <br />0 <br />4scr►DeAow your project will benefit the City of Paris and its citizens:6" 6 A•'Afit o <br />ikl1 l ~ A t 1 tl Ic <br />~ <br />. . I <br />r- <br />r, <br />~ <br />t° <br />A <br />List other sources of funding for this project and the amounts: <br />~ ~ <br />i4 <br />~ <br />Is a detailed project budget, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? ['es ❑ No <br />Is the agency's most recent financial statement or audit attached? [,u Yes ❑ No <br />Have you received funding from the City of Paris in the last five years for this or any other project? ❑ Yes 0`No <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• - <br />City of Paris 53 (c) Revised 6/10/08 <br />