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46 <br />40 <br />40 <br />L 6lmarai Information <br />Applicant Organization's Legal Name: Indian River County Sheriff's office <br />Applicant Agency EIN Number (assigned by the IRS. This number should be nine digits): <br />Ofthe office of Justice Programs has assigned your department an ELN Number, please use that assigned number. Otherwise. your Internal <br />Revenue Service £lN number should be used. For further clarification, please refer to your apptfcation nistrtiruon manual on page 5. I <br />Applicant Agency ORI Number:. (assigned by FBI for UC'i2 reporting) <br />PL03100 <br />(chis should be 7 digits long beginning with file first two letters ofyour state abbreviation. ,dor firrther clarifiratron. please refer to 3 -our <br />application instruction manual on page 5 .) <br />Federal Congressional District Numbers: 15 <br />Are you contracting for law enforcement services? ❑ Yes 31 No <br />If "Yes, " enter the name and agency information of the contract low enforcement department in the Executive <br />information section below For further clarification in determining if this applies to your agency, please see <br />the Application Instruction Manual on Page 5. <br />I. Exna t e Inforll Uon <br />(Must be the highest ranking official in both categories) <br />Law Enforcement Executive's Name: Gary C. Wheeler <br />Title: Sheriff Agency Name: Indian River County Sheriff's Office <br />Address: 4055 lat Ave <br />City: Vero Beach <br />State: RL Zip Code: 3296o -Laos <br />Telephoner 561 478-6444 Fax: 561/569-8133 <br />Type of Police Agency: <br />El Municipal ❑ State El County PD 1E7 Sheriff" a Tribal* ❑Transit* <br />❑ School* ❑ University/College' (Cl Public or © Private ) <br />* Public Housing* ❑ New Start Up* (please specify type of agency): <br />Oth * lease s ecify): <br />er (p p <br />'Departmems applying from agency types with an asterisk next to them must complete the ad <br />dNionaf �n/arena+tar: questronnoares contained to rhe <br />application kit. This additional information must be submitted with your application <br />Government Executive's Name: Fran B. Adams <br />Title: Chairman Name of Government Entity: Board of county Cottmrissioner& <br />Address: 1844 25th St <br />City : Vero Beach <br />State: FL Zip Code: - <br />Telephone: 561/567-8000 Fax: <br />11AS In schools <br />