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INDIAN RIVER COUNTY NONPROFIT / QUASI AGENCY REQUEST FOR FUNDING <br />A. Program Cover Page <br />Agency: Veterans Council of Indian River Telephone: <br />County, Inc <br />... ...... .. .... . <br />Contact Person: Patricia Geyer -Patton Fax: <br />Title: Chair - Finance Committee E -Mail: <br />Address: PO Box 1354 <br />772-205-1995 <br />000-000-0000 <br />natririainavarnnlrimniI rr <br />Website Address: www.veteranscouncilirc.org <br />6 <br />Program Title: Transportation Services for Veterans <br />I Agree - By checking the "I Agree" box and entering your name below, you certify that information <br />contained in this application accurately reflects the activities of this agency and that the expenditures or <br />portions thereof for which County funds are being requested are not reimbursed by any other source. <br />Name: Ken Dale Title: Treasurer <br />tsrleT oescn tion OT the vro ram Tor wnicn Tuncling 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 at <br />no charge to the veteran. <br />aummary me or[ <br />Amount requested from Indian River County for 2021/2022: 94000 <br />Total Proposed Program budget for 2021/2022: 94000 <br />Percent of total Program budget: <br />100% <br />Current Funding (2020/2021) 90000 <br />Dollar increase / (decrease) in request: $4,000.00 <br />............................... <br />Percent increase / decrease in request: 4.44% <br />it request Increases 5-/o or more, bnetly explain why: <br />n/a <br />The Organization's Board of Directors has approved this application on (date): 03/31/2021 <br />Name of President/Chair of the Board: <br />Name of Exec. Director/CEO: <br />Martin J. Zickert, Colonel (Ret.) USAF <br />James Romanek <br />165 <br />