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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: LLt,rY\Cty( l,0un6 ~ctn &sakxCes Date: In lio <br />Agency Mailing Address: f • o•--6 Oi LA <br />Agency Phone Number: q03 Agency Fax Number: (q03)1gy"2L05,9 <br />Contact Person 0. Luf'Q Contact's Title: <br />Contact's Mailing Address: S4X`r1f, O~S aIWC, <br />Contact's Phone Number: it Contact's Fax Number: i' <br />Contact's Email Address: l r. ~l YG eA (D SUc~,Qn 11 nLmo_l I - c-o 1'Y-) <br />Name of Project• 1M e0..1 S o►Z W h~~ S <br />Location/Service Area of Project: ~~►5 ax-,J t-aXra f t4)L^4U <br />Total Project Budget: $ Total Amount Requested from City: $ I2l 040 •00 <br />Number of Beneficiaries: Summary of Project: Se e A4Q 61,Pd n/) <br />Describe how your project will benefit the City of Paris and its citizens: <br />See, <br />List other sources of funding for this project and the amounts: <br />S e~. ,e <br />Is a detailed project budget, Zes uding columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? ❑ No <br />Is the agency's most recent financial statement or audit attached? ZYes ❑ No <br />Have you received funding from the City of Paris in the last five years for this or any other project? Kl~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 vear awarded: Se< *'T'cLC` l'e <br />Revised 7107/09 <br />City of Paris ffiIBIT A <br />