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REQUEST FOR PUBLIC FUNDING <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, if necessary). In addition, please <br />submit with this form a copy of your agency's most recent financial 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: <br />Agency Mailin <br />Agency Phone Number:C r' 9%(~Agency Fax Number: ~ <br />T`~ -T- <br />Contact Person: Contact's Title: L4r,4:J, <br />n ~ <br />Contact's Mailing Address: s t ~~v~ -~•t.;i - 7~X. 7 ~ df-~L~f <br />Contact's Phone Number: G` L' Contact's Fax Number: <br />ContacNs Em <br />Name of Proj <br />Location/Seri <br />Is a detailed project budget, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? BfYes ❑ No <br />Is the agency's most recent financial statement or audit attached? Yes ❑ No <br /> <br />Have you received funding from the City of Paris in the last five years for this or any other projeci~ !0. '<Yes ❑ 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: ~ 1 tl`'() 1ti ~ r~ Q "vv ~ ~ <br />J ~7, . - / r, . - h <br /> <br />City of Paris E%HIBIT A Revised 7/07/09 <br />Describe how your project will benefit the City of Paris and its citizens: ,(„~U <br />1, 1~ Y a,. .a . ~ ✓ ~ ~l . n e ~ , 1! _ . A . , 1 / : . n . Xn L, 1 <br />List other sources of funding for thfls praject and the amaunts: <br /> <br />,r~.?a X. .~/7u 41 i..ILHCI <br />Total Project Budget: Total Amount Requested from City: $~3";~'T~ <br />ci": ~,w <br />Number of Beneficiaries:A ~ S~ummary of Project: -W- ~2 L% <br />