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<br />\ 1. For A TPA Use Only 3. a. Date Submitted b. Applicanlldenlifier <br />2. slale Program Classification (For ATPA Use Only) 4. a. Date Received by State b. State Application Identifie:r <br />5. Applicant Informalion <br />a. Legal Name: c. Organized Unit: <br />b. Address (give street or P. O. Box, City, County, State, and Zip Code) d. Name and telephone number of person to be cbntacted on matt~rs <br /> involving this application (give area code) <br />6. State Payee Identification Number: 7. Type of Applicant (enter the appropriate letter in box) <br /> 0 <br /> A. Stale H. Independent School District <br /> B. County I . State Controlled Institution of Higher Learning <br /> C. Municipal J. Private University <br /> D. Township K Indian Tribe <br /> E. Interstate L. Individual <br /> F. Intermunicipal M. Nonprofit Organization <br /> G. Special District N. Other (specify): <br />8. Type of Application: 9. Name of Grantor Agency: <br /> D New o Continuation D Revision Texas Automobile Theft Prevention Authority <br /> If Revision, check appropriate box(es). 4000 Jackson Avenue <br /> Austin, Texas 78779 <br /> D Increase Award D Decrease Award D Other (specify) <br /> Increase Duration D Decrease Duration D <br />10. Title of Project: 11. Areas of Project Activities (Cities, Counties, States, etc.) <br />12. Proposed Project 13. Is application subject to review by state executive order 12372 process? <br />Start Dale: YES, this application was made available to the Texas Review and Comment System (fRACS) <br /> for review on <br />Ending Date: Date <br />14. Funding Summary: . NO. D Program is not covered by E. O. 12372 <br />Total of a, b, & c must agree with d. <br />a. Total State Grant Funds $ . Program has not been selected by state for review \. <br /> Requested (ATPA) <br /> 15. Is the applicant delinquent on any federal debt? <br />b. Cash Match $ <br /> In -Kind Match $ D YES If "Yesh attach an explanation D NO <br />c. <br />d. TOTAL s $ <br />16. To the best of my knowledge and belief, all data in this application is true and correct. The document has been duly authorized by the governing body of <br />the applicant and the applicant will comply with the attached assurances if the assistance is awarded. <br />a. Typed name of Authorized Official b. Tille c. Telephone Number <br />d. Signature of Authorized Official e. Date Signed <br /> <br />ApPLICATION FOR STATE ASSISTANCE <br />AUTOMOBILE THEFT PREVENTION AUTHORITY (A TPA) <br /> <br />ATPA-1 <br /> <br />EXHIBIT A <br />