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40 <br />Farmworker Housing Assistance Act <br />APPLICATION FOR GRANT ASSISTANCE <br />Facesheet/Certification <br />Submission Date: <br />Type Sponsor (check one): x Nonprofit organization _Local public body <br />Sponsor: <br />Name I <br />lossAddress Street <br />City Vero Beach <br />County Indian River <br />Phone ( 305 ) 567-8000 <br />Authorized Representative of Sponsor: <br />Name Indian River County Hmu;ing Aii+-hnri i4 <br />Address 1840 25th Street <br />City Vprn TAParh _ <br />County Tndi nn Ri vPr <br />Phone ( 305) 567-80nn FX+- 497 <br />TYPE APPLICATION BY PROGRAM CATEGORY (check at least one category and <br />indicate the amount requested) <br />() Preapp loan and grant <br />paging <br />() Final app loan and grant <br />packaging <br />() Earnest money <br />(x) Rehabilitation <br />Administrative Fees <br />TOTAL Amount of Grant Request <br />O Self-help housing $_ <br />$ ( ) Counseling component $ <br />() Initial operating expenses $ <br />$ ( ) Management ;component $ <br />$ ( ) Site Acquisition $ <br />$2s_7a— <br />$. 77R <br />other funds requested from federal, state, local or private sources for purposes of <br />site acniisition, construction, renovation, maintenance and support of the Farmmrker <br />Housing Centex. <br />N/A <br />Name of Fur -ding Acrency Address Amount Purpose of Funding <br />1. <br />2. <br />3. <br />The grant application is composed of a 1) facesheet/certification, <br />2) checklist and 3) a series of attachments. The application should be <br />compiled in the order identified on the checklist and, where applicable, <br />the 14LP printed forms should be utilized. Any item not included in the <br />application should be discussed in a narrative explaining the reason for <br />the omission. The narrative should be inserted in the position designated <br />for the omitted item. <br />Approve , t !orm <br />and to al <br />Gar - 10. Bran Wnbur <br />Dated Ju unty AttorI <br />The applicant certifies that the <br />inf¢¢x,mation in this application is <br />tAed correct and authentic. <br />4!t_trp of AtdthoE�zQd olfficial <br />a ric s, airman <br />RnArd of (;minty rnmmiQCinnPYC <br />The Annlication for Grant Assistance (Grant Arnlicant <br />Checklist) is on file in the Clerk's Office. <br />15 <br />