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All Applications Must <br />Be Postmarked <br />OCT 1 g 1971. <br />To Be Accepted for <br />Processing <br />APPLICATION FORM FOR THE <br />LOCAL GOVERNMENT COMPREHENSIVE PLANNING <br />ASSISTANCE PROGRAM <br />TO BE SUBMITTED TO: Mr. John Sidor, Jr., Director <br />Division of Technical Assistance <br />Florida Department of Community Affairs <br />2571 Executive Center Circle, East <br />Tallahassee, Florida 32301 <br />APPLICANT (city, county): <br />City of Fellsmere Indian River <br />ADDRESS: TELEPHONE: <br />P. 0. Box 38 <br />Fellsmere, Florida.32948 305-571-0116 <br />CHIEF ELECTED OFFICIAL: TELEPHONE: <br />Homer D. Simpson, Mayor 30S-571-0116 <br />The Applicant certifies that to the best of his knowledge and belief, the data <br />in this preapplication are true and correct, and the filing of the preapplica- <br />tion has been duly authorized by the governing body of the Applicant as con- <br />firmed by an attached resolution. <br />September 15, 1977 <br />Signature of the 'Chief Date <br />Elected Official <br />NOTE: Application must be signed by the chief elected official and include all <br />identifying information, fiscal need information, and a resolution from the <br />governing body. A separate application must be submitted �Z each governmental <br />unit that is included in a'off int application. <br />FOR JOINT APPLICANTS ONLY: Please indicate below the designated common plan- <br />ning entity which will be responsible for the work to be performed: <br />Russell & Axon <br />Name of Entity <br />(' a <br />_ Y F <br />James Steffens " (904) 255-5471 <br />Contact person and phone number <br />1620 Mason Ave.,Daytona Beach, Fla. 32015 <br />OCT 5 1977 1XI PAU2,'31 <br />