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4„J Grant Coversheet Form . 1. ENTER the legal name of the organization: 12. a) ENTER the Authorized Official Information: City of Paris Title (Mr., Ms., Dr., Judge, etc.): Mr. 2. ENTER the title of the project Name: Michael Malone Red River Valley Drug Task Force Position: City Manager 3. ENTER the division or unit to administer the project Address: P.O. Box 9037 Police Department City /State(Zip. Paris ITexas 75461 4. ENTER the agency's State Payee Identification Number. Telephone: 903 785 -7511 x 2011 Fax: 1903 785 -8519 1- 7560006359000 E -mail: m malonea(�ci.paris.tx.us 5. a) Is the applicant organization delinquent on any State or Federal debt? (SELECT One): No b) ENTER the Project Director Information: Title (Mr., Ms., Dr., Judge, etc.): Chief b) ENTER the date of the last audit: 11/07/2001 Name: Kart Louis c) ENTER the agency fiscal year Oct 1 -Sept. 30 Position: Chief of Police 6. SELECT the funding source: Address: P.O. Box 9037 City/State(Zip: Paris Texas 75461 Byrne Formula Grant Program (federal CFDArl6.579) 7. ENTER the grant period (ex: mm/dd/yyyy): Telephone: 903 785 -7511 x 239 Fax: 903 737 -4142 From: 06/01/2004 To: 05/31/2005 E -mail: k louisoci.paris.tx.us B. ENTER the current grant number if a continuation project c) ENTER the Financial Officer Information: 13854 -05 Title (Mr., Ms., Dr., Judge, etc.): IMr. 9. Budget Information (figures filled in from Budget Form) : Name: W. E. JAnderson CJD Funds Cash Match In -Kind Total Position: Director of Finance $739,722 $311,434 $0 $1,051,156 Address: P.O. Box 9037. 10. a) Is this a local or regional project? (SELECT One): Yes City /State/Zip: Paris Texas 75461 b) If you marked 'Yes', for Step 10. a) ; is this application subject to a regional COG prioritization process? (SELECT One): Telephone: 903 785- 7511 x241 Fax: 903 785 -8519 No E -mail: q andersono_ci.paris.tx.us c) If you marked 'No', for Step 10. a) or b) ; then is this application subject to the State's TRACS process pursuant to 1 TA.C. § §5.191- 5.253? (SELECT One): No 13. SELECT your organization type based on the list of eligible applicants by fund source: City d) If you marked'Yes' for Step 10. a) , SELECT the regional COG in which this project is geographically located: 14. a) SELECT the headquarters county: Lamar Ark -Tex Council Of Governments - Region 0500 b) LIST the cities and counties within the service area: 11. a) Is this grant application is response to a Request for Applications (RFA) as published in the Texas Register? (SELECT One): Cities of Paris, Bonham, Sulphur Springs, Mt. Vernon, and Cooper, and counties of Lamar, Fannin, Hopkins, Franklin, and Delta. No _ b) If you marked'Nd, ENTER the name of the CJD staff member that you contacted for submission: Judy Switzer :. ..:....... ... 15. FOR COG USE ONLY a) Is this application shared with another COG? (ENTER "Yes" or "No!): b) CPTN #: d) COG Application ID: c) Priority #: Page 1 of 1 I-Ex. 15 1 T A Coversheet Form