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REQUEST FOR PUBLIC FUNDING <br />. <br />ivun-pront agencies requesting funding from the City of Paris for projects that benefit th <br />~~b~~~Qs must complete <br />the following information to be eligible for consideration (you may use additional pages, if necessary U addition, please <br />submit with this form a copy of your agency's most recent financial statement or ~t'a <br />project. Agencies must also make a brief presentation on their project at a city council m~'~ budget for the <br />Agency Name• ~NSA -Q/; ; Date• <br />Agency Mailing Address: Locp <br />Agency Phone Number:_ 3 -1 ~ Agency Fax Number: <br />4/ 10~ <br />Contact Person: Contact's Title:~l~1 <br />Contact's Mailing Address: c~a Cat 0 a R(n <br />Contact's Phone Number: <br />Contact's Email Address: 'a r-o e ~ <br />Name of Project: <br />Contact's Fax Number: ~ i~ ~ ~ - <br />a_ <br />u, <br />r~ <br />~ <br />Describe how your project <br />AA. 11.11 <br />'o C~ rs`f- <br />i rl'1~ z- i l `e-a&[ o <br />List other sources of funding for <br />the City of Paris and its citizens: IlL~f <br />~7 ~ <br />~s Lv <br />`u.,P C'.-e_',L.n <br />project and the amounts: <br />1 " ' !3 d 1,55 <br />Is a detailed project budget, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? ;K'yes ❑ No <br />Is the agency's most recent financial statement or audit attached? X Yes R No <br />Have you received funding from the City of Paris in the last five years for this or any other project?gYes ❑ 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 • y~~ co, J <br />crJn <br />City of Paris <br />~ Revised 6/10/08 <br />a <br />LocationJService Area of Project:_q~a 1 11 j ( ~ ~ 1- ~ ~ ~ ~ <br />