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1119*0 <br />FLORIDA FINANCIAL ASSISTANCE FOR COMMUNI'Py rbE. <br />RVICES ACT OF 1.74 <br />(COMMUNITY SERVICES TRUST FUND) <br />GRANT APPLICATION Page I of 7 <br />REPLY TO: <br />DEPARVIE'NT OF COv*1UNITY AFFAIRS <br />I C E OF COMMUNITY SERVICES <br />2571 EXECUTIVE CENTER CIRCLE, EAST <br />TALLAHASSEE, FLORIDA 32301 <br />1. Local Governmental Unit Applying for Grant: <br />Nanl^: --7`41M.1 .7j? - r �!!-, - !( - - - w:)mrry <br />Mame: amof Lon, city or county) <br />Address; G;"!';,!lry VERU BEACH, F:. <br />SUB141T FOUR (4) COPIES <br />(ONE MUST BE ORIGINAL) <br />PLEASE TYPE - ANSt:ER ALL <br />QW".STIONS <br />Telephone: (.301) <br />:Este Aijoncy Indian River County Council on Aging <br />ty o I., <br />1 a C t I i r, perste:,. <br />should questions ari <br />Telepht-ne: p-") <br />Vol - <br />zip: f•: <br />1:1(1 address Of person authorized to receive fund.,;. I <br />dace" will be t thisperson. A'I 1. c h e c k <br />p1ly:1510 to tht, local <br />No I -.I,? 110111zl-'; lilt'.0" <br />Indiall River colll.Ly <br />Address ('01-Inty COLII-thOUSe, V(!110 j1j(1,jCjj Florida 32960 <br />will :,',; ., t,, in thu program alter this grant CX,:.''. <br />in Feder;il r3ii1),m allow.mcon. <br />w i I 1 ('10 the 'I Hd i. L of t Im program? <br />1,idian River County <br />H <br />