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STATE AGENCY REQUEST FOR FUNDING FROM INDIAN RIVER COUNTY <br />FISCAL YEAR 2019/2020 <br />A. Program Cover Page <br />Agency: <br />Contact Person: <br />Title: <br />Address: <br />Florida Forest Service <br />Tim Elder <br />Forestry District Manager <br />5200 Highway 441 North <br />Okeechobee, FL 34972 <br />Telephone: (863) 467-3220 <br />Fax: (863) 467-3223 <br />E -Mail: Tim.Elder@FreshFromFlorida.com <br />Website Address: www.freshfromflorida.com/Divisions-Offices/Florida-Forest-Service <br />Program Title: <br />Fire Control Assessment <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 />Print name and title <br />Brief description of the Proram for which fundinis re.uested: <br />Fire Control Assessment for FY 2019-2020 Indian River County <br />Summary Report <br />Amount requested from Indian River County for 2019/2020: <br />Total Proposed Program budget for 2019/2020: <br />Percent of total Program budget: <br />i Current Funding (201812019) <br />Dollar increase i (decrease) in request: <br />Percent increase / decrease in request: <br />S 13,821.36 <br />13,821.36 <br />0/0 <br />S 13,821.36 <br />If request increased 5% or more, briefly explain why: <br />The Organization's Board of Directors has approved this application on (date): <br />Name of President/Chair of the Board Signature <br />Name of Exec. Director/CEO <br />Signature <br />119 <br />