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REQUEST FOR PUBLIC FUNDING <br />Non-profit agencies requesting funding from the City of Paris for projects that benefit the citizeh f Parrs "Ecomplete <br />the following information to be eligible for consideration (you may use additional pages, if ne y please <br />submit with this form a copy of your agency's most recent financial statement or audit anA~~il~~X get for the <br />project. Agencies must also make a brief presentation on their project at a city council meeting. <br />Agency Name: <br />Agency Mailing Address: <br />Agency Phone Number: <br />Contact <br />Agency Fax Number: <br />MsContact's Title: ~ <br />te: 'I I q t C)-_ <br />Contact's Mailing Address: ~~a ly\'P <br />Contact's Phone Number: Contact's Fax Number: ~"c"~J1't-~-`~_~ <br />Contact's Email Address: <br />CO <br />Name of Project: <br />Location/Service Area of Project: L__~_4r" 'd- <br />Total Project Budget: D ~~C Total Amount Requested from City: $ S,~ fl ao <br />Number of Beneficiaries: t'S0$Qmary of Project: e CLU-C~-+vo 11L Li ~z <br />Describe how your project will benefit the City of Paris and its citizens: <br />~ ov,~ 6ur <br />~ 0-v~.~' C~ ck N L e <br />List other sources of funding for this project and the amounts: N Cak Sr lo <br />Is a detailed project budgyt, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? N1AYes ❑ No <br />Is the agency's most recent financial statement or audit attached? ~Yes ❑ No <br />Have you received funding from the City of Paris in the last five years for this or any other project?xYes ❑ 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 />_ , I _ t , i, <br />a„d the vear awarded: <br />City of Paris <br />ffiIBIT A <br />