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AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY �' <br />FISCAL YEAR 2018/2019 / e <br />A. Program Cover Page <br />APR � .f l{#?� <br />Veterans Council of Indian River 772.410.580 <br />Agency: County, Inc. Telephone: -m <br />Contact Person: Dillon Roberts Fax: n/a <br />Title: Treasurer E -Mail: info@veteranscouncilirc.org <br />Address: PO Box 1354 <br />Vero Beach, FL 32961 <br />Website Address: www.veteranscouncilirc.org <br />Transportation of veterans to the <br />Program Title: Veterans Administration Medical <br />Center, West Palm Beach, FL <br />I certify that information contained in this application accurately reflects the activities of this agency and <br />that the pendifures or portions thereof for which County funds are being requested are not reimbursed <br />by any <br />Dillon Roberts, Treasurer <br />Signat re Print name and title <br />Brief description of the Program for which funding is requested: <br />The Program provides transportation for veterans and caregivers from Indian River County to and from <br />medical appointments locally and to the Veterans Administration Medical Center in'West Palm Beach, FL <br />at no charge to the veteran. <br />Amount requested from Indian River County for 201812019: $86,300 <br />Total Proposed Program budget for 2018/2019: $86,300 <br />Percent of total Program budget: 100% <br />Current Funding (2017/2018) $84,160 <br />Dollar increase / (decrease) in request: $2,140 <br />Percent increase / decrease in request: 2.5% <br />If request increased 5% or more, briefly explain why: <br />The Organization's Board of Directors has approved this application on (date): 3/28/2018 <br />Colonel US Arm ret <br />Name of President/Chair of the Board Signature n <br />Bruce Cady, USMC <br />Name of Exec. Director/CEO Signature <br />