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REQUEST FOR PUBLIC FUNDING <br />iNon-pro2it agencies requesting tundmg trom 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 addrtional 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 NameM(OAp (:`~J r-)i+NL fyhRo~- Date: W / ~ ~ <br />Agency Mailing Address: <br />Agency Phone Number: Agency Fax Num er: ~ <br />Contact Person:Contact's Title: C <br />5 , <br />Contact's Mailing Address: P a0. <br />Contact's Phone Number: 1~~a~7 Contact's Fax Number:_ Q --7 <br />Contact's Email Address: <br />Name of Project: <br />- r ~ <br />Location/Service Area of Project: -7 -7 7 <br />- ~ <br />Summary of Project: ~ r U-, Qr <br />G~. S c 1 <br />o nco ~ <br />I A~t ~In <br />~r <br />C'% Lr.dl !•_7 <br />Describe how your project will benefit <br />~ ~ 1 11 , . . I . <br />List other sources of fundin for this <br />gJr'c ~ <br />of Paris and its citizens: <br />t I <br />and the <br />P61F, <br />, 0- <br />W-9. on <br />~q <br />-QZ <br />C-1 <br />Is a detailed project budget, including columns and descriptions for allocations of city funding and the agency's <br />matching funds, attached? ~Yes ❑ No <br />Is the agency's most recent financial statement or audit attached? Xyes ❑ No <br />Have you received funding from the City of Paris in the last flve years for this or any other project?)~'1'es ❑ No <br />If you have receiv previous city funding, list the name of the roject, the amount of the City's award, and the <br />year awarded: v`~ , ~ ~ nq , ~ , <br />City of Paris Revised 6/10/08 <br />FXHIBIT I~- <br />