Laserfiche WebLink
Attachment C <br />Page 1 of 4 <br />Administrative Use <br />FLORIDA <br />AMERICA THE BEAUTIFUL (ATB) <br />URBAN AND COMMUNITY FORNMY GNAW APPLICATION FORM <br />1992 <br />GSNERAL INSTRUCTIONS: Please complete all items pertaining to the <br />Category Grant for Which you are applying. The application packet <br />must not exceed (15) fifteen pages front and back or (30) thirty <br />one sided pages, excluding asps and plans. All attachments must be <br />8 1/2" Z 11", except any attached sketch", plans and maps Which <br />snot be no larger than 21 Z 3" and folded into 8 1/2" E 11". Tan <br />(10) copies (twpacket <br />ncluoriginals � (0) i mt tocopies) te of the <br />ro project <br />application packet incl app�liaa <br />dsacription and all attacb is east b rsosieid no later than <br />2:30 p.m. July 31, 1992_at: <br />Department of Agriculture sed Caasusaz Services <br />Purchasing Office - AM - 92 Ap 2JrATION <br />Mayo Building - Roan 69 8 <br />Tallahassee, FL 32399-0800 <br />Telephone (904) 488-7552 <br />If you have any questions, please see Attachment D, "Where to Go <br />for Help" <br />APPLICANT INFORMATION (Please Print or Type) <br />Project Title: Indian River County - Urban Upland ahi rat Man;1"Ment Plan <br />Applicant Name (Local Government, Volunteer Organization or <br />Educational institution): Indian River County <br />Name and Title of Contact Person: Christine Pani m, Spni ar ravi =mental planner <br />Address 1840 25th Street, Vero Beach <br />Zip: 32960 Phone:.( app 1.5628400 ext. 215 <br />Is your organization a not for profit corporation pursuant to <br />Chapter 617, Florida Statutes? Yesx No <br />FEID Number 596000674 <br />Is your organization tax exempt under IRS code? Yes-_X__No <br />As the duly authorized representative of the Applicant named above, <br />I hereby certify that all parts of the application and required <br />grant information have been read and understood and that all <br />information submitted herein is true and correct. <br />Authorized Executive Officer: Carolyn K. FggPrt <br />Title: ChaMM,Board of 29AU <br />Signature - Date -�T _ O <br />