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• <br />4W <br />Applicant l r0W <br />Fedusl kMntFW <br />OMB Approval No, 0348--Do43 <br />Identlrbr <br />.palHsrne - <br />Application for Federal. <br />Drgwdtaduroi Vnl <br />Assistance <br />1 <br />2. Dale submitted <br />Iddress (" CMV, County, aisle, and 2000th): <br />1 Type of Submission; 3. Date RecoNed by Slab <br />Name, lolephono number. and IacalnlN nur ber of the person to be contacted on <br />Application Proappllcatlon <br />n Construction ❑ Construction 4. tale Reo&gd by Federal Agency <br />1840 25th St. <br />U Non•Constwelion El Non -Construction <br />Louise S. Hubbard MPA <br />S. Appauntintonnallon <br />Applicant l r0W <br />Fedusl kMntFW <br />OMB Approval No, 0348--Do43 <br />Identlrbr <br />.palHsrne - <br />Drgwdtaduroi Vnl <br />Indian River County <br />Board of Count Commissioners -. <br />Iddress (" CMV, County, aisle, and 2000th): <br />Name, lolephono number. and IacalnlN nur ber of the person to be contacted on <br />ratters <br />ilvdvbrp Lhis application (Dive arae Cod") <br />1840 25th St. <br />Louise S. Hubbard MPA <br />Vero Beach, FL 32960 <br />(561) 231»5860x260 <br />FAX Number: 234-52 9A <br />s.EmployertdanufrullcnHumb►r(SINI: <br />7. Type of Applicant: ,anter r4pproprlatta letter In Lox) <br />I L J L_ <br />A. State H. Independent School Dili <br />.. .. <br />B. County I. Stale Controlled Instlttltlon of Hlghor Learntnp <br />_.- --- <br />5.11ypeofApplkation: <br />C. Municipal J. Private University <br />New C) Continuation ❑ Revision <br />D. Township K, Indian Tribe <br />E. InterstateL. Individual <br />If Revision, enter appropriate letter{sl In box(osy <br />F. Iniarmuniclpal M. Profti Otgatlaatlon <br />7I <br />G. Special 46etdct N. Non•proflt <br />Ll <br />Other (Specify): <br />A. Increase Award 8. Decrease Award C. increase Duration <br />e.NameotFodaralAyermy: <br />U.S. Dopartmentof Housingand Urban [level opmont <br />D. Docroass Duration Other (speclly): <br />10. Cal Mot; oIFWoralDornsetleAsWet once Number. <br />t1.Ueac.rlptiveThIsofApplicant's Proje : <br />1 �+ —L2 <br />� <br />13 11_41 <br />FAMILY OPTIONS TRANSI'T'IONAL <br />71110 <br />HOUSING FOR FAMILIES WITH CHILDREN <br />Supportive Housing <br />Program <br />rransitional Housing and Support <br />for up to 12 families at one time <br />- <br />12. Areas Atrocted by project (clua . colnlies.. sates, etc.): <br />o find permnent housing. Families <br />Indian River St. Lucie, <br />P <br />tay 6mos.-2 years and work with a <br />13.Propoosdprof set; <br />14.Congrerslonel Dlstrlctsot. <br />Stan Date EnoingDara <br />a. Applicant <br />It. Props <br />15 <br />15 <br />15. Eellmated Funding; <br />16. la Applicatlen Subject to Review bV state Exrcutive Otdor 12312 Proceea7 <br />r <br />a. Yes This preapplication/appiication was made avaltable to the <br />State Executive Order 12372 Process for review an: <br />tl <br />r' <br />Date: <br />b. No Program is not Covered by E.O. 12372 <br />C Sialic %.° i <br />or Program has not been selected by State for review. <br />17,IttheApplloont Delinquent on Any Federal Debt? <br />E] Yes If 'Yes. explain Wow or attach an explanation No <br />Loea a z <br />F <br />is Toth c best of my knowledge and belief, all data in thi s appiication/preappl ication are true and co rrr ct, the doc ament. W been duly authorized <br />by the governing body of the applicant and the applicant will comply with the attached assumnces if Use assistance is awarded. <br />a Typed Nang or A utnortzed Raprftoal&Ws b. Tpla 1c.Tolophoneflurnbu <br />d. &9nnlure <br />Dale Wall <br />Editions Nr1 Usable Paye i o1 2 form &F -V4 (41'91e) <br />Pfltrlaibed W OMS 0reu4r A-102 <br />