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ID Code to be Assigned by State EMS Office: MI <br />Florida Department of Health and Rehabilitative Services <br />Office of Emergency Medical Services (EMS) <br />MATCHING GRANT APPLICATION <br />1. <br />Legal Name of <br />Agency/Organhation: Indian River County Emergency Medical Services <br />Name and Title of <br />GrantSigner: Richard N. Bird, Chairman Board of County Commissioners <br />Mailing 1840 25th Street <br />Address: Vero Beach, FL 32960 County: Indian River <br />Telephone Number: (407) 567-2154 SunCom Number. 224-1444 <br />2. <br />Name and Title of <br />Contact Person: James A. Judge, Chief of Emergency Medical Services <br />Mailing 1840 25th Street <br />Address: Vero Beach, FL 32960 <br />Telephone Number: (407) 567-2154 SunCom Number: 224-1444 <br />3. <br />Legal Status of <br />Agency/Organization: Mink only ons) <br />Feiner Not for Profit (yrs mret Fervid' ow of eerdfiter) <br />Your (beau yam <br />10/1/92 9/30/93 <br />1110111! NNW <br />_ <br />Now for Profit XX yob <br />— <br />4. <br />Agency/Organization's Federal <br />Tax Identification Number digits VF 5 9 6 0 <br />0 0 6 7 4 <br />nine <br />S. <br />Application Status: (Mole air ewe) <br />Tho it die semi—doe of a polar Wordy Ihwded by deo Mw ®Ns mobbing Prem <br />pegrare. <br />Mr yon <br />XX This M as der eoinirwodoe of a molest shoofly ended by the WO DN! Reeding <br />6. Type of Project: (mak wily ens): <br />.Xu. <br />Cwawrwi mieaa <br />lwegerrtr Tempest Whim — Pablo 1/wades <br />srrtr.1wMredeefQaeMrr Aetweao _ aeeeawb <br />Me/kaYlattww yaimmot (et mMem a "wiled hi aero IA sal Ne) <br />eemtuuMs Pesbmiewnl ldneartee (moMral dbumw tent dee arm 1!a) <br />Does few pejeet imbeds dao member" of my teamweloalMne 'grimmer/ <br />