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Il Farmworker Housing Assistance Act APPLICATION FOR GRANT ASSISTANCE Facesheet/Certification Submission Date: Type Sponsor (check one): x Nonprofit organization Local public body y Sponsor: Authorized Representative of Sponsar:_ Name I Name Indian River Co= Housing Alii-hnri t -z Address 1840 25th Street Address 1840 25th Street City Vero Beach City Vern Reach County Indian River County Inr3ian River Phone ( 305 ) 567-8000 Phone ( 305) 567-8nnn m?xi- -ig7 TYPE APPLICATION BY PROGRAM CATEGORY (check at least one category and indicate the amount requested)- () Preapp loan and grant Paging () Final app loan and grant packaging () Earnest money (x) Rehabilitation Administrative Fees TOTAL Amount of Grant Request () Self-help housing $ $ \ ( ) Counseling component $ () Initial operating expenses $ $ ( ) Management c=ponent $ $ ( ) Site Acquisition $ $25,,77A $29077R Other funds requested from federal, state, local or private sources for purposes of site acquisition, construction, renovation, maintenance and support of the Fanruorker Housing Center. N/A Name of Funding Acrency Address Amount Purpose of Fundincr 1. 2. 3. The grant application is composed of a 1) facesheet/certification, 2) checklist and 3) a series of attachments. The application should be compiled in the order identified on the checklist and, where applicable, the 14LP printed forms should be utilized. Any item not included in the application should be discussed in a narrative explaining the reason for the omission. The narrative should be inserted in the position designated for the omitted item. Approve s ; form and le al Cy Gar, 44 1. Bran renbu Dated JUN 51985 The applicant certifies that the infmation in this application is t e, correct and authentic. $ic�nat> reB.ot A tho zed fficial a ri.c S. airman Rnnrd of (minty Cnmmiccinnerc The Anplication for Grant Assistance (Grant Arnlicant Checklist) is on file in the Clerk's Office. 15 Boor. PAGE 56