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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 />. <br />project. Agencies must also make a brief presentation on their project at a city council meetin(y <br />'C~1 r 0 <br />Agency Name: Date• <br />Agency Mailing Address: <br />4 <br />b <br />N <br />F <br />~ ~ <br />' <br />T11 <br />Agency Phon umber:_q Cl?)":7 <br />er: <br />um <br />ax <br />Agency <br />3 - <br />k~~ <br />rl <br />~ <br />Contact erson: <br />tact'1Vraili g~Iddr ss: C"" <br />C <br />Contact's Title: Cr <br /> <br />~ <br />-7 G <br />~ <br />on <br />~ 7 e <br />Contact's Fax Numb <br />Contact's Phone Number: 0 ~~1 ~ - i ~ <br />o" J i~ <br />- <br />Corntact's Emai; Arldress• <br /> <br />1 <br /># <br />Name of Project• <br />~ <br />n <br />e, <br />' <br />- <br />P` <br />7 <br />Location/Service Area of Project: 1 <br />~ <br />ti <br />C <br />Total Project Budget: 2- <br />( Total Amount Requested from City: $ l.J r <br />r, <br />Number of Beneficiaries )•6,~ <br />; <br />Summary of Project: <br /> <br />Describe how our project will benefit the City of Paris and its citizens: U-1 ( ' <br /> <br />` ,on)~,,,~ <br />r <br /> <br />iry) C~CL <br />:9 <br />~ <br />~ ' +'~A LKJ- <br />-~)n <br />~ <br />~•~j ~,ar~ .SZ„ ~ i <br />. <br />1.~~.1 ~ L.J ~ ~ <br />~ ''1 ~ <br />~ <br />'st other sources of funding for this pro'ect and the ounts: <br />~'Ev <br />Is a detailed project bu get, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached. Yes No <br />~ ❑ x cPerC~.~i ~ <br />, ~ <br />Is the agency's most recent financial statement or audit attached9 . XYes ❑ No <br />Have you reccived funding from the City of Paris in the last five years for this or any other project? 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: <br />Revised 7/07/09 <br />City of Paris EXHIBIT A <br />