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I.. sal:-ec_lanatcry. <br />2. project S_cnser - ?lac= the ••'=.e off the ellgible govern^ental agency <br />receiving !--ancial assistance • <br />3. `ru r - Each req :est s cu13 �e ^ :�bered staj=.;, �,�'_t.. _` e <br />caest se the _y nal". <br />,=.her one (1) 1! this is _ last billing, 3:ec- <br />�. ?av to - ?lace the name of the ._o ect Sconsor exact'_y as wishas <br />the State •-•as_ant to ':e :jade _aya'_ <br />e$t ?er.cd Covered - . ote t: e Oates of t v _er4cc -=cn *MP <br />'• . eC' rend-:CT_=e: ses in-Var--ed agar -st e <br />request, to "_ e cur re _Lest. - - <br />current recuest gust t:zis pe__cd. <br />6. <br />Zte.as in t,.Iis section are to be dis= La;ped in tpo (2) main categories <br />as s'rcwn in column headings: <br />a. self-ax?lanato;!. I <br />b. Self-e:c2lanatcry._ <br />c. 'totals - '.rhen _..taling under "'total Cblicatlor.s to Ddce " col'-', <br />i.clv.de aMount in ct:.r_ent request. <br />will depend cen the ty,e o: <br />d. This <br />teased (2/3) , cc=inaticn (11/3). :he stet_ <br />rea,_*Sted must not emcn-••a the. -;e ratios. <br />* ~" the total rj_.4_c'= '_ccal stare '_s to <br />cash to Project construction, thesecra_-cs Must be ad`.er"-= <br />with each _al'LlLC2..^.nn r^C' C I_ a,11 cr Ca== the <br />to 4� stem to :a c�� �, ------d i:�`lan3` ra' �e (; Lc:aae or <br />local re i3 <br />Y.Cn@'!'_"r, = ' <br />do <br />donation) these eat'Os -!0ct 3pp1'7. "�t=�- <br />':ill to released Ong ;J _er project costs =Q <br />the mount c= 3oc_=entea ex=^nc____es -or items or z- <br />7-3. DNR CF'?C✓ CS% C:' -Ly <br />9. Sal; <br />1..�,7.q dc�.Le - neS the Hepar= -m-3 nt <br />The �..=;ilaC'1re raC^ .. .tin _ is <br />= SCI ^es "se. <br />