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Application Profile <br /> Form G - 1 (Continued) <br /> Demographics <br /> U . S . Congressional District Number 15 <br /> Florida Senate District Number 26 Florida House District Number 29, 80 <br /> Census Place Unincorporated Census Tract n/a Census Block Group (s) n/a <br /> INDIAN RIVER COUNTY <br /> Grant Request : Maximum grant requests are based on the jurisdiction 's LMI population as determined by HUD . Please see <br /> the table below . <br /> LMI Population Maximum Grant Request _ <br /> ! 1 – 499 $600, 000 . 00 <br /> !— <br /> 500 - 1249 $ 6501000 . 00 <br /> 1 , 250 – 31999 $700, 000 . 00 � <br /> 4, 000 – and above I $7501000 . 00 <br /> Local Government's LMI Population 28, 162 Grant Request $ 750,000 <br /> Answer the following questions by circling the correct response . <br /> Historic Preservation Yes No <br /> Will the project impact a building , public improvement or planned open space more than 50 years old ? <br /> j(See instructions . ) <br /> Interlocal Agreement Yes No <br /> Will project activities require an interlocal agreement? If yes, the interlocal agreement must be provided in the Supporting <br /> Documentation Section . (See instructions . ) <br /> State of Financial Emergency Yes No <br /> Has the local government been declared to be in a state of financial emergency pursuant to Section 218 . 50 – 218 <br />. 504 , F . S . , at <br /> any time during the two years prior to submission of the application ? <br /> Grant Preparation Costs <br /> The applicant may request grant funds for the cost of grant application preparation . See instructions if funds are <br /> requested . <br /> Does the applicant wish to request grant funds for the cost of grant application preparation ? Yes <br /> No <br /> Amount $ 3, 000 Advertising, If yes, grant preparation cost documentation must be included in the Supporting Documentation <br /> Section . <br /> Mailing _ <br /> National Flood Insurance Program – Indicate whether or not the local government is a current participant in the <br />NFIP . ! Yes _�No _ <br /> 5 <br />