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tiVE <br />Y <br />LOCAL JOBS GRANT PROGRAM APPLICATION <br />I. APPLICANT INFORMATION: lease Fill In the Grey Shaded Cells <br />Kessel Medical, Inc. <br />Jack Cabell Griffis, III <br />Business Name <br />Donald Kenneth Griffin, H <br />Jack Cabell Griffis, III <br />Address <br />Donald Kenneth Griffin, II <br />Zip Code <br />Business Owner(s) Full Legal Name(s) <br />(e.g. John Howard Smith, Jr. <br />Jack C. Griffis, III <br />Officers Full Legal Names <br />Agent(s) Full Legal Name(s) <br />(Enter Officers in multiple lines above) <br />2345 14' Avenue, Suite 10 Vero Beach <br />Florida 32960 <br />Address City <br />State Zip Code <br />404-583-6889 i riffis(a)kesselmedical.com www.kessehnedical.com <br />Phone Number E-mail <br />Website <br />Jack Cabell Griffis III <br />CTO <br />Contact Person (Full Legal Name) <br />Title <br />Business Unit's Federal Employer Identification Number: <br />87-3981137 <br />Business Unit's Unemployment Compensation Number: <br />13826710 <br />Which of the following best describes this business: <br />Yes/No <br />X New business to Indian River County <br />Existing business in Indian River County <br />If an expansion, how many jobs are currently in the business? NA <br />II. PROPOSED SITE LOCATION <br />if known): <br />UNKNOWN AT THIS TIME <br />Vero Beach <br />TBD <br />Address <br />City <br />Zip Code <br />UKNOWN AT THIS TIME LL BE INDIAN RIVER CO <br />Properly Parcel Number(s) <br />Current Location (if different) <br />2345 14'' Avenue, Ste 10 <br />Vero Beach <br />32960 <br />Address <br />City <br />Zip Code <br />Unknown <br />Property Parcel Number(s) <br />