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DEPARTMENT OF COMMUNITY AFFAIRS <br />COMMUNITY SERVICES BLOCK GRANT <br />APPLICATION <br />APRIL 1, 1986 - SEPTEMBER 30, 1986 <br />2 of 11 <br />DCA USE ONLY <br />Postmark Date: <br />Date Receiveds <br />Revision Rec'd:_ <br />CONTRACT NO: <br />ALLOCATION AMOUNT $ <br />DATE APPROVED% <br />acaoasaamaaaaaana=aamwmwmwwmmmaaaasaamwmft- mmacmmca=asmassmmaamaw mmswwammmwm co <br />INSTRUCTIONS: Please complete all parts in this Application which are <br />applicable to your organization. If any part does not apply, write "N/A". <br />Do not use white-out (correction fluid) on any part of this application. <br />m.-.=..aaa===maaa=aaas amaamammwmmmamwmma....masa=aaaaoass=a.aaa==awamasma seam a masa <br />I. APPLICANT CATEGORY: (XI Local Government ( I Eligible Entity <br />Migrant/Seasonal <br />Farmworker <br />Organization <br />II. GENERAL ADMINISTRATIVE INFORMATION <br />a. Name of Applicant: Indian giver CoMty <br />b i Applicant's Address: 1840 25th Street <br />City: fro Beath. �jOrida Zip Code��0-339 <br />Telephone: (305)567-8000 County : Tnd' n River <br />c. Applicant's Mailing Address (if different from above): <br />2001 9th AUpnue. Vero Beach, Florida Zip Code 32960 <br />d. Chief Official or Executive Director's Name: Edward .T. Regan <br />Title: Executive Director <br />e. Name of Official to Receive State Warrant: Indian River County Finance <br />Department <br />Address: 1840 25th Street <br />Vern Beach Florida Zip Code 32960-3394 <br />f. Contact Person: Edwin M_ Fizz Title: nirec- nr Finan.. <br />Mailing Address: 1,$40 251-h Street <br />Vern ifflch. Florida Zip Code:32960-3394 <br />Telephone: (305) 567-8000 Ext 205 <br />g. Tax Exempt Number: 03 000 17 05 41 <br />(Non -Profits Only) <br />III. SUBGRANTEE INFORMATION <br />a. will these funds be transferred to a subgrantee? (x) Yes ( I No <br />b. Give the number of subgrantees included in this application: 1 <br />List for each (attach additional pages if necessary:) <br />Subgrantee Name: Indian River County Housing Authority <br />Address: 2001 Buildina Suite 302, 2001 9th Avenue , Vero Beach, F1.,12960 <br />Contact Person:Edward J. Regan Telephone:(305)567--8000 Ext 322 <br />