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.•,11WL0RIDA <br />FINANCIAL ASSISTF� <br />e OR COMMU11"Ty <br />SERVICES <br />- <br />',CT OF i•�7.1 <br />Signature: <br />(COMMUNITY SERVICES T1 UST <br />FUND) <br />s <br />GRA.11T APPLICATION Page 1 of 7 <br />REPLY TO: * <br />SU13I4I7 FOUR (4) COPIES <br />DEPT-',M'-:-P;T OF M-2-1UNITY AFFAIRS (ONE MUST 2E ORIGT?,1i:I,) <br />10E Ui' c UiLiSUNI'1'Y 5L•'RVICE5 <br />2571 E?{ECUTIV CENTER CIRCLE, EAST * PLEASE TYPE - 1,NS,:ER ALL <br />TAILAHnSSEE, FLORIDA 32301 QUESTIONS <br />1. Local Governmental Unit Applying for Grant: <br />T`IDTAIJ PT�r1; r; ciUpl'('Y Tc <br />'� lc�phonr_: (sr�'•) Sr„''-•�11�3G <br />(name of town, city or county) <br />Address: c.,n 'TY c(M.TFHOUr"";) yf-"fM 131;nCH, F(. )'k*j )J1 zip 3; F0 <br />C--"unt`_' Ii!i l.nlJ !ii.'v1;H CU1;!'I'Y <br />A-J0ncy (:,) : Indian River County Council on Aging <br />o lilt : 1y <br />I 1 (Uur Depa. t me.z t: <br />t'iis parson should questions_-- <br />';.trr <br />'uun'-y <br />Tulephrrile . <br />Cour•i.huuse Vero _.:�ch, <br />Florid:: 3'19`0 <br />Signature: <br />.1. N :ne and address of person authorized to receive funds. I f t: -is ap_ <br />Irl. i ::t tion ir; funded, checks will Ise mailed to this person. All checks <br />t 11. he ma<ar� p �y;thlc: t:O 010 local gover.nnent. <br />1'r.rr.;y" 'i'hvinas 1nt.eri.;overnmr�nLal Caordr co <br />"11-L'.1 <br />lnclian Hivec•11-L'.1 <br />Address: H00:71 11'• - County Courthouse, Vero Beac}i, Florida 32960 <br />zip: 32.i-)0 <br />"....... » A.+'r..9.•i•K.7g,.t �:.:41ti[.3•.t�Yb^..dS.�u•A:..a�.�.>.•:., ��..:..M..>�.b �_,.,y....i..�....:, .�..., ,.. ...,.�.�... .. '..'..• _... ... •, � .. <br />will ::u;t,:in the program after this grant expires? <br />Tr, r� ri <br />in Fedora l 511-l),,int <br />1 i . whi) wi l l do the -mdi. t of the prograin? <br />Ir,•1 i an River County per: onnel. <br />AUG 141980 BOOK 44 PAE 393 <br />r <br />