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ECEiVE <br />R.EQUEST FOR PUBLIC FUNDING <br />Non-profit agencies requesting funding from the City of Paris for projects that benefit the citize'.s~Ya1AANAGE~'plete <br />the following information to be eligible for consideration (you may use additional pages, if necessar~~~R~a~~~, please <br />submit with this form a copy of your agency's most recent fmancial statement or audit and a detailed budget for the <br />project. Agencies must also make a brief presentation on their project at a city council meeting. <br />Agency Name• a,i Date• <br />Agency Mailing Address: C) 7-) G -7 S L( L2 <br />Agency Phone Number: Agency Fag Nurnber. <br />_ <br />Contact Person: CR&6~ O 6- Nn~(2~. ~k~Contact's Title: C CJ <br />ContacNsMailingAddress: ~ b C~ <br />Contact's Phone Number: ~ ~r -(1) 3 ~ q Llq j - (,0J Contact's Fax Number: <br />Contact's Email Address: <br />Name of Project,& <br />Location/Service Area of Project: ~ <br />Total Project Budget: $~2~~ Total Amount Requested from City: L t SQ ~ <br />N ber of Beneficiaries: Summary of Project: R <br />~ r~ _ r,-.. „ _ \ ~r~....,.. `:....n <br /> <br />Describe how your project will benefit the City of Paris and its citizens: <br />List other sources of funding for this project and the amounts: \IV~;~~~ <br />I r'1 I , tl\ r' <br />Is a detailed project budgef, ikluding columfi''s and descriptions for allocations of city funding and the agency's <br />matching funds, attached? ❑ Yes ~Vo <br />Is the agency's most recent financial statement or audit attached? ❑ Yes [~oHave you received fundinb from the City of Paris in the last five years for tliis or any other project? P~s EU-N-a' <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: <br />City of Paris I2evised 7/07/09 <br />E%HIBIT A <br />