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AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2018/2019 p'~►�`� <br />A. Program Cover Page <br />Veterans Council of Indian River 772.410.5820 Oy 12lUrU <br />Agency: County, Inc. Telephone: <br />Contact Person: Dillon Roberts <br />Fax: <br />n/a <br />Title: <br />Treasurer E -Mail: <br />Address: <br />PO Box 1354 <br />Vero Beach, FL 32961 <br />Website Address: <br />www•veteranscouncilirc.org <br />Transportation of veterans to the <br />Veterans Administration Medical <br />Program Title: <br />Center, West Palm Beach, FL <br />info@veteranscouncilirc.org <br />I certify that information contained in this application accurately reflects the activities of this agency and <br />that the pe or portions thereof for which County funds are being requested are not reimbursed <br />by any o r,� rce. <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 />Summary Kepori <br />Amount requested from Indian River County for 2018/2019: $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 />" e <br />��yle Sam Keuns. Colonel US Army (ret <br />Name of President/Chair of the Board <br />Bruce Cady USMC <br />Name of Exec. Director/CEO <br />