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WDA FINANCIAL ASSISTANCEWCOMMUNITY SERVICES ACT IM74 <br />(C0MMUNITY SERVICES TRUST FUND) <br />GRANT APPLICATION Page 1 of 7 <br />REPLY TO: <br />DEPARTMENT OF COMMUNITY AFFAIRS <br />DIVISION OF COMMUNITY SERVICES <br />2571 EXECUTIVE CENTER CIRCLE, EAST <br />TALLAHASSEE, FLORIDA 32301 <br />1. Local Governmental Unit Applying for Grant: <br />* SUBMIT FOUR (4) COPIES <br />(ONE MUST BE ORIGINAL) <br />* PLEASE TYPE - ANS117ER ALL <br />QUESTIONS <br />Name: Indian Rimer Co. Telephone: (30j562_7927 <br />name of town, city or county) <br />Address: P.O. Box 1028 Vero Beach Fla zip: X2960 <br />° County: Indian River <br />2. Delegate Agency (s) : Vocational Training and Sheltered Workahnp <br />3. Person with over-all responsibility of grant: (Our Department will <br />contact this person should questions arise) <br />Name: John M. Rezanka Telephone: (305)56 _r 5& <br />Address: 1385 16th Ave Vero Beach Fla 32960 <br />Signature: <br />4. Name and address of person authorized to receive funds. If this ap- <br />plication is funded, checks will be mailed to this person. All checks <br />will be made payable to the local government. <br />. � . Wrl r2=8119 a WOMB <br />Address: Q. Box 1028 rmirt-finust, Annex <br />Vero Beach Fla Zip: 32960 <br />0 <br />- - DOOR <br />MAR 191900 - <br />43 : p4U 14-x` <br />