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nooi irnTinni CnoTvr'f1Rr ACCIfTANIrF <br />OMB Approval No.0348-004J <br />1 TYPE OF SUBMISSION <br />2. DATE SUBMITTED: <br />APPLICANT IDENTIFIER: <br />Aaolication: Pre-application: <br />7 Construction F-I Construction <br />3. DATE RECEIVED BY STATE: <br />STATE APPLICATION IDENTIFIER: <br />~ Non-Construction <br />i <br />- <br />on <br />I Non-Construct <br />F <br />4. DATE RECEIVED BY fEDERAL AGENCY: <br />FEDERAL IDENTIFIER: <br />5. APPLICANT INFORMATION: <br />Leoal Name: <br />Oraanizational Unit: <br />licant <br />de) of a <br />d Zi <br />C <br />S <br />Name/Title Agency or Company, Address Area Code Telephone and Fax Numbers, <br />pp <br />o <br />tate an <br />p <br />Address (City. Counly <br />and e-mail address of applicant oreoarer: <br />6 EMPLOYER IDENTIFICATION NUMBER (EIN): <br />6a DUNS NUMBER: <br />7 TYPE OF APPLICANT: <br />8 TYPE OF APPLICATION: <br />~ A. Municipal ~ B. County <br />~ New ~ Continuation ~ Revision <br />9 NAME OF FEDERAL / STATE AGENCY: <br />10 CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: <br />14-228 Title: Texas Community Development Block Grant Program (TxCDBG) <br />Office of Rural Community Affairs <br />11. PROJECTTYPE: <br />11a TYPE OF APPLICATION: <br />Community Development Fund <br />12 TARGEf AREA(5) AFFECTED BY THE PROIECT: <br />13. APPLICANTS FISCAL YEAR: <br />Beginning Date: Ending Date: <br />14 CONGRESSIONAL DISTRICTS: Representative: Senate: Congress: <br />15 ESTIMATED FUNDING: <br />16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCE55 <br />A. TxCDBG REQUEST: <br />Yes the preapplication / application was made available to the State Executive <br />B. FEDERAL: <br />~ Order 12372 process for review on: <br />C. STATE: <br />Date: <br />D. APPLICANT: <br />F] No <br />E. LOCAL: <br />~ Program is not covered by E.0.12372 -OR- <br />F. OTHER: <br />E] Program has not been selected by the State for review <br />G. TOTAL: <br />17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />~ Yes. If "Yes", attach an explanation. D No <br />TO THE BEST OF MY KNOWLEDGE AND BELIEF ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY <br />18 <br />. <br />AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE CERTIFICATIONS AND CITIZEN PARTICIPATION PLAN INCLUDED <br />IN THE PROCEDURES SECTION OF THE TxCDBG PROGRAM APPLICATION GUIDE IF THE ASSISTANCE IS AWARDED. <br />licanYs Authorized Reoresentative: <br />f the A <br />d N <br />T <br />b Title of the Applicant's Authorized Renresentative: <br />c Telephone Number <br />pp <br />ame o <br />ype <br />a <br />d Signature of the A12alicant's Authorized Representative: <br />Date/Time Field <br />Previous Editions Not Usable I HIVUHttU rvren wty ~nLv-~oj <br />Page 3 of 16 <br />