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<br /> <br /> <br /> RECEIVE- <br /> REQUEST FOR PUBLIC FUNDING <br /> G 6' <br /> Non-profit agencies requesting funding from the City of Paris for projects that benefit the citizefi f Parts ° `complete <br /> the following information to be eligible for consideration (you may use additional pages, if ne nV66 , please <br /> submit with this form a copy of your agency's most recent financial statement or audit anWA! d} et for the <br /> project. Agencies must also make a brief presentation on their project at a city council meeting. ) <br /> ' 1 { ( C <br /> Agency Name: C~A_ ~2 k iUs ate: Q <br /> Agency Mailing Address: S / <br /> Agency Phone Number: 7 !X,a Agency Fax Number: 0C7~S - ~ J 2- L(37(a <br /> Contact Person: C~ FO t-D IR(. V-Q.iJ ieSContact's Title: C_ E_ <br /> Contact's Mailing Address: g tyNe <br /> Contact's Phone Number: ~x.ry'e Contact's Fax Number: je~JYt1`~ . M-q 30 <br /> Contact's Email Address: V_ (04 CWsg,_aJ~IL K-J-S• 0-0 (11, <br /> <br /> Name of Project: J sx 4a_ 1<10S <br /> Location/Service Area of Project: !-.a m-a-, LA_ <br /> Total Project Budget: $ T ©c S Total Amount Requested from City: $ ~r ao <br /> <br /> Number of Beneficiaries: {S09Qmary of Project: (2 &U,0, LJ ~c7 <br /> -4 o' O N c1 D <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Describe how your project will benefit the City of Paris and its citizens: t l~ <br /> <br /> fl- o r e c-D+e 6ur- <br /> LOYvIlmu M O v`~' C ft to N ~ <br /> <br /> 2 L <br /> List other sources of funding for this project and the amounts: N Cat St <br /> 0,~x 'S+-. Zoe <br /> 0-bm ry\, UL " I -:Fb u-kj t t <br /> <br /> Is a detailed project budg t, including columns and descriptions for allocations of city funding and the agency's <br /> matching funds, attached? VYes ā‘ No <br /> <br /> Is the agency's most recent financial statement or audit attached? Sallyes ā‘ No <br /> Have you received funding from the City of Paris in the last five years for this or any other project?Yes ā‘ No <br /> <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: CA!5A FL C) LUe 4w P~ <br /> bU c7 <br /> <br /> a r~ <br /> City of Paris Revised 7/07/09 <br /> EXHIBIT A <br /> 0141 <br />