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INDIAN DIVER COUNTY STATE AGENCY FUNDING REQUEST <br />MAR 7 ,9 7Q21 <br />A. Program Cover Page <br />Agency: oVFlorida orest Service Telephone: (863) 467-3220 <br />Contact Person: Tim Elder Fax: <br />Title: Forestry District Manager E -Mail: Tim.Elderp_FDACS.gov <br />Address: 5200 Highway 441 North <br />Website Address: ttps://www.fdacs.gov/Divisions- <br />Offices/Florida-Forest-Service <br />Program Title: Fire Control Assessment <br />Agree - By checking the "I Agree" box and entering your name below, you certify that information <br />contained <br />in this application accurately reflects the activities of this agency and that the expenditures or portions <br />thereof for <br />which County funds are being requested are not reimbursed by any other source. <br />Name: Lisa Ridley Title: Administrative Assistant I <br />Brief description of the Pro ram for which funding is requested: <br />Fire Control Assessment FY 2021-2022 <br />_qiyrnm, nr Qo ,f, <br />Amount requested from Indian River County for 2021/2022: $13,821.36 <br />................................................................................... . <br />Total Proposed Program budget for 2021/2022: $13,821.36 <br />............................................ ..... <br />Percent of total Program budget: 100 <br />Current Funding (2020/2021) $13,821.36 <br />Dollar increase / (decrease) in request: $0.00 <br />Percent increase / decrease in request: 0 <br />I 11 iequesi increasea o io or more, nrieiry explain why: <br />i ne Urganization's Board of Directors has approved this application on (date): . 03/11/2021 <br />Name of President/Chair of the Board: <br />Name of Exec. Director/CEO: <br />N/A <br />N/A <br />97 <br />