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AGENCY REQUEST FOR FUNDING FROM INDIAN RIVER COUNTY <br />FISCAL YEAR 2014/2015 <br />A. Program Cover Page <br />Agency: <br />Contact Person: <br />Title: <br />Address: <br />Website Address: <br />Program Title: <br />Mental Health Court PrograrTielephone: <br />Judge Cox/Sheriff Loar Fax: <br />E -Mail: <br />2000 - 16th Ave #383 <br />Vero Beach, FL 32960 <br />Mental Health Court/Diversion <br />14•2) -d -- <br />772-226-3235 <br />772-770-5335 <br />dloar@iresheriff.org/ <br />coxc@circuitl9.org <br />I certify that information contained in this application accurately reflects the activities of this agency and <br />that the expenditures or portions thereof for which County funds are being requested are not reimbursed <br />by any other source. <br />Sheriff Loar/Judge Cox <br />Signature Print name and title <br />Brief description of the Pro ram for wmcn tunaing is re uestea: <br />A mental health court that diverts criminal defendants <br />suffering from a mental illness to community services <br />in lieu of incarceration <br />Summary Report --- <br />Amount requested from Indian River County for 201412015: $ 100,000 <br />Total Proposed Program budget for 2014/2015: $ 100,000 <br />Percent of total Program budget: 50 % <br />Current Funding (201312014) $ 0 <br />Dollar increase / (decrease) in request: $ <br />Percent increase / decrease in request: % <br />If request increased 6% or more, briefly explain why: <br />The Organization's Board of Directors has approved this application on (date): <br />Name of President/Chair of the Board <br />Name of Exec. Director/CEO <br />Signature <br />Signature <br />31T_A <br />