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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 />4. Agency/Organization's Federal <br />Tax Identification Number nine digits VF 9 _5_ Q g . � Z <br />5. Application Status: (coot only o.$) <br />xx <br />This 1. dror soatirw.do. of • p,ojat shady hods/ by dr..r.w. EMS siwhlo/ goat potww. <br />This is pN doe sondrsr doa of s yrvjwt shady Minded by dr. M. P1Ws .wehh>t rent prog.s. <br />6. Type of Project: (flak only a..): <br />ca.w.r.ie.does _ Condamine Profs Taal R/wod.: Wass' &Wm omni. ass IS.) <br />XX Ilimsrremsy Tamped V Ms?,, !/...d.. <br />Sydow R,sk.ds lQ..firy Aaw..to _ assea.0 <br />_. MedkaJR..ew fy.y.r.r. (eid.wa is uI./ fir Isms IA ..d IA) <br />Dees yoer Project krlts& do* ywch.a of soy tomwr.kaiw.«dy.md <br />_ Yes __XX <br />1. <br />Legal Name of <br />Agency/Organization: Indian River County Emergency Medical Services <br />Name and Title of <br />GrantSigner. Richard N. Bird, Chairman Board of County Commissioners <br />Mailing 1840 25th Street <br />Address: Vero Beach, FL 32960 <br />County: Indian River <br />Telephone Number: (407) 567-2154 <br />SunCom Number. 224-1444 <br />2. <br />Name and Title of <br />Contact Person: James A. Judge, Chief of Emergency Medical Services <br />Mailing 1840 25th Street <br />Address: Vero Beach, FL 32960 <br />Telephone Number: (407) 567-2154 <br />SunCom Number: 224-1444 <br />3. <br />Legal Status of <br />Agency/Organization: (Chat only on.) <br />Pdvw Not for Profit (jai.md provide my etaNfkw) <br />Your lbeal leer: <br />10/1/92 9/30/93 <br />MINS INDS <br />Nom for Profit Malls <br />_ <br />4. Agency/Organization's Federal <br />Tax Identification Number nine digits VF 9 _5_ Q g . � Z <br />5. Application Status: (coot only o.$) <br />xx <br />This 1. dror soatirw.do. of • p,ojat shady hods/ by dr..r.w. EMS siwhlo/ goat potww. <br />This is pN doe sondrsr doa of s yrvjwt shady Minded by dr. M. P1Ws .wehh>t rent prog.s. <br />6. Type of Project: (flak only a..): <br />ca.w.r.ie.does _ Condamine Profs Taal R/wod.: Wass' &Wm omni. ass IS.) <br />XX Ilimsrremsy Tamped V Ms?,, !/...d.. <br />Sydow R,sk.ds lQ..firy Aaw..to _ assea.0 <br />_. MedkaJR..ew fy.y.r.r. (eid.wa is uI./ fir Isms IA ..d IA) <br />Dees yoer Project krlts& do* ywch.a of soy tomwr.kaiw.«dy.md <br />_ Yes __XX <br />