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EXHIBIT A <br />AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2019/2020 <br />A. Program Cover Page <br />( <br />Veterans Council of Indian River <br />Agency: <br />County, Inc. <br />Contact Person: <br />Pat Geyer <br />Title: <br />Chair— Finance Committee <br />Address: <br />PO Box 1354 <br />Vero Beach, FL 32961 <br />Website Address: <br />www.veteranscouncilirc.org <br />Transportation of veterans to VA <br />Program Title: <br />medical facilities locally and West <br />Palm Beach <br />Telephone <br />Dir. Line <br />E -Mail: <br />772.410.5820 <br />772-205-1995" <br />pat@veteranscouncilirc.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 />- Matthew Scheidel, Treasurer <br />Scr <br />ign toe / 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 />JLJ111111d1Y r\UIJUIL <br />Amount requested from Indian River County for 2019/2020: $90,000 <br />Total Proposed Program budget for 2019/2020: $90,000 <br />Percent of total Program budget: 100% <br />Current Funding (2018/2019) $86,300 <br />Dollar increase / (decrease) in request: $3,700 <br />Percent increase / decrease in. request: 4.3% <br />If request increased 5% or more, briefly explain why: <br />The Organization's Board of Directors has approved this application on (date): March 27, 2019 <br />Dar e "Sam" Kouns. Colonel US Army (retL <br />Name of President/Chair of the Board SignatbTe <br />Ken Dale Sgt. Ist Class US Army <br />Name of Interim Exec. Director <br />Signa <br />EXHIBIT A <br />