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REQiEST FOR PUBLIC FCJNDING <br />Non-profit a;encies requesting fundin; from the Ciry of Paris for projects that benefit the citizens of Paris must complete <br />the followin; informadon to be eli;ible for consideration (~~ou may use additional pages, if necessary). Tn addition, please <br />submic with this form a copy of your agency's <br />most recent fmancial stacement or audit and a detailed budget for fhe <br />project. Agencies mosC also mal:e a brief presentadon on their project at a city council meeting. <br />Agency Name: 1=/~c <br />w6 1ta ri~ Fa~t ix (5A r- -L-- Date: (e - i 1 <br />ency Mailing Address:L V Q C")c .27 <br />A <br />Mo t,tvrt ~ I r",i t T X `77 LI 56 .33 '7 <br />g <br />Agency Phorie Number: ~O3 5-7A y 7 <br />3 Agency Fax Number: q63 5 7,~ - S, a <br />Contact Persoa: 2 oL 6Re5 t, ,x m <br />Contact's Title: t= X-e ~ u+,Lt 1), 2et-~o (7_ <br />Contact's Mailing AddXess: 1° ba ~A 33 <br />2. Pt-e_rx~.c nt i X!7-34 S d-~~~ 7 <br />Contact's Phone Number: IV 7 o i <br />'1- 3 _ Contaet's Fax Number: c103 517 ~ C ri <br />Contact's Etnail Address: ~ if-ee +c)v, 4cL <br />~E' -tCi.C'~C:'1!N • Crn <br />Name of Project: <br />adon/Service Area of Pz-oject: <br />I <br />~4' ~ lu P~Cr_~5 TX <br />,oc <br />i t1 M et i,,+nw, ria,- <br />Summaty of Project: <br />644' cz I F) P rX S~n.k r,i< lb,11s <br />, <br />~ 1 Ff C~-I f t ~7~1 i~ &'~Cf1_45 P) V-i-n'f i CY\ ' I b <br />~ 11L~' ~'~f C ~ 1<;"•<J G1'1 S-P ~'D 9-{. k.-ue0 (i e.L I f3 C,f I t: <LL I <br />,I C' <br />Describe how your project v;zII benefft the City of Paxis and its citizens: t,2.u-0'~04er i.L~1lI <br />ek- PCcht Qaf'~s U 1G~i ~r+C o,l Ah,dse Ifr~ S kP a l7 [-Wcc n a,m( L, v; cc :z -I-~,~ <br />~L le-ct C4- --E- VCY41141S oI 0wnca.6c 0C?4,)6L C'cJLc.t"t-{o <br />1-t utk A-t W:r 6nj, a r i S Ai- C11n.C C7~c 1 ~~v~( tr ~4 c~~m Rnu ~ ~ ~`G <br />Y.ist other sources of funding for this project an.d the atnounts: Ckn i-~c( Lt,s~ja„g~~; n1~~ 1 lJ) t~C1, <br />lY1 j'DIA✓rltt~i~~~) ~ I `o GOiI _ <br />Is a detailed plroject budget, including columns and descriptions for allocations of city £unding and the agebcy's <br />matching funds, attached? CDYes ❑ No I&N-t l.-(Ea-vJ ht`{`I -tt <br />Is the agency's most recent financial statement or audit attached? RYes ❑ No <br />Have you received fundang frotn the City of Paris in the last f5ve years for this or any other project? Q'Yes ❑ No <br />If you have received previous city funding, Iist the name oY the project, the amount of the Cicty's award, and the <br />yearawarded• ~2016 u~o~~Esf;c V,`64,la 74c"<f L~/ao ,5~~ u"aq <br />City of Paris E-x Revised 6/l.0/OS <br />h'~ b'~-t <br />