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• <br />AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2019/2020 <br />A. Program Cover Page �Pf' ; l <br />Veterans Council of Indian River <br />Agency: Telephone: 772.410.5820 <br />County, Inc. _0, sc,S <br />Contact Person: Pat Geyer Dir. Line 772-205-1995 <br />Title: Chair — Finance Committee E -Mail: pat@veteranscouncilirc.org <br />Address: <br />PO Box 1354 <br />Vero Beach, FL 32961 <br />Website Address: www.veteranscouncilirc.org <br />Program Title: <br />Transportation of veterans to VA <br />medical facilities locally and West <br />Palm Beach <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 />Sign 'atuw'e <br />Matthew Scheidel, Treasurer <br />Print name and title <br />Brief description of the Pro • ram 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 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 />Current Funding (2018/2019) <br />Dollar increase / (decrease) in request: <br />Percent increase / decrease in request: <br />$90,000 <br />$90,000 <br />100% <br />$86,300 <br />$3,700 <br />4.3% <br />If request increased 5% or more, briefly explain why: <br />N/A <br />The Organization's Board of Directors has approved this application on (date): March 27, 2019 <br />Darryle "Sam" Kouns, Colonel US Army (ret) <br />Name of President/Chair of the Board <br />Ken Dale, Sgt. !st Class, US Army <br />`t <br />Signage <br />Name of Interim Exec. Director Signat <br />199 <br />