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RECEIVED <br />REQUE5T FOR PUBLIC FUNDING r;C, E; ~g-1,n <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, ifayffsAWA.NtA(ftion, please <br />submit with this form a copy of your agency's most recent financial statement or audit aiBU76eflEMSudget for the <br />project. Agencies must also make a brief presentation on their project at a city council meeting. <br />Agency <br />Agency <br />Agency Phone Number: f, a Agency Fax Number: <br />Contact Person: T) a ti_t"+- Contact's Title: ~~11 t c 1W,:Q1_e2 1' <br />Contact's Mailing Address: 1)a ~iQ7X 7 57 <br />Contact's Phone Number: :7 5~ i-f-- t If t I Contact's Fax Number: <br />Contact's Email <br />Name of Project: <br />Location/Service <br />Total Project Budget: $ I~ 1 !j10 Total Amount Requested from City: $ S Q`;~~)7; <br />~ <br />Number of Beneficiaries: ' ~Summary of Project:~~`~~, ~J ~A..2r <br />n ' d ~ n ° _ . n fl . Fi • . <br />Is a detailed project budget, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? [irYes ❑ No <br />Is the agency's most recent financial statement or audit attached? Yes ❑ No <br />✓~{.i`~- rL ..dL~L~' <br />Have you received funding from the City of Paris in the last five years for this or an ' other projeci~ M'I'es ❑ No <br />If you have received previous funding from the City, list the name of the project, the amount of the City's award, <br />and the year awarded: V-e o[,%() <br />~a 'W'1 <br />,G, <br />~ <br />City of Paris Revised 7/07/09 <br />` _ 818 <br />Describe how your project will benerit the City of Paris and its citizens:"I <br />A - _ t P ~ , - . --4 _ ; ,G . , _ . . ~ ~f)` . i ~ i L,. V_ M ~ <br />List other sources oi tuncting for this project and the amounts: t c' -0 .,44- <br />j~~ i ~ { 4~ ; <br />/ U~rlsn`°.k",'1C'~i , ~t" .:s~.'~',:, ,f~.lt, X.I %I.K,a T/.AHr,~_A <br />' <br />