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ATTACHMENT A 1g. 1 of 11 <br />APPLICANT SUBMISSION FORM <br />FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS <br />COMMUNITY SERVICES BLOCK GRANT APPLICATION <br />APRIL 1, 1986 THROUGH SEPTEMBER 30, 1986 <br />SUBMITTED BY: rndi a&_XeX Caine - <br />(AP LICANT) <br />N <br />Application is hereby made for funding through the Community Services Block <br />Grant under the Community Services Block Grant Act of 1981 (PL 97-35), as <br />amended, and the Community Services Block Grant. Program Administration <br />Rule 9B-22, Florida Administrative Code, effective March 1984. <br />THE APPLICANT CERTIFIES THAT THE DATA IN THIS APPLICATION AND IT VARIOUS <br />SECTIONS, INCLUDING BUDGET DATA, ARE TRUE AND CORRECT TO THE BEST OF HIS <br />OR HER KNOWLEDGE AND THAT THE FILING OF THIS APPLICATION HAS BEEN DULY <br />AUTHORIZED AND UNDERSTANDS THAT IT WILL BECOME PART OF THE AGREEMENT <br />BET BEN THE DEPARTMENT AND THE APPLICANT. <br />Dor. C. Scurlock. Jr.� <br />Name (typed) <br />Signa uxe <br />Chairman of -Board Of CounttyCcrtimissioners <br />Title: <br />ATTESTED BY: 1'reda Wright _ <br />Name (typed) Signature 113 <br />Jam^ <br />Clerk of the Board of. County Ccunissioners <br />Title <br />Al,prov-,d as to form <br />and Icgal suffieienlccyy. <br />Charles-� <br />County Atlorm: y <br />APPLICATIONS MUST BE POST14ARKED BY THE DUE. DATE, FEBRUARY 10, 1986 AND <br />RECEIVED WITHIN FIVE DAYS AFTER THAT DATE TO DE CONSIDERED FOR FUNDING. <br />Form:DCA/Css <br />86-I <br />