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Department of Community Affairs <br /> Enterprise Business Application <br /> (Complete both forms for each PAPERS User) <br /> Part 1 - Organization Information <br /> Organization Code:[? 1 (County-use FIPS code, for cities - numeric descriptor) <br /> FEIN Number : '-75q— <br /> (Government and Non-government - federal identification number (FEIN), Individuals - <br /> social security number) . , ? <br /> 1 <br /> Organization Name: �'t' �a vim' "14- <br /> Address Line One: h <br /> Address Line Two <br /> City: _ <br /> County: <br /> State: <br /> Zip: �l <br /> Zip Plus: <br /> Country (United States or other): IV,-3. <br /> Organization Web Site: WwW.i rCao <br /> Organization Description:, <br /> Business Sector (Local Government or Priva •e For-Profit): c-air�roZ -✓ r� <br /> Part 2 - Contact Person (PAPERS User) <br /> Name Prefix: /W. <br /> First Name: <br /> Last Name: m�✓� <br /> Middle Initial:(Optional) f <br /> Name Suffix:(Optio al <br /> Position Title: sr <br /> Alternate Address Li ne: <br /> (If different than above) <br /> Alternate Address�ine Two: <br /> Business Phone: C 772) -5i--7—�sGGt? <br /> Business Extension:(Optional) /Z57 <br /> Alternate Business Phone:(Optional) <br /> Business Fax:(Optional)C! 72�"7 7--�jr <br /> Alternate Business Fax:(Optional)�`77� -770 X 31 <br /> Mobile Phone:(Optional) <br /> Mobile Pager:(Optional) <br /> E-Mail:(Required) <br /> Alternate City: J (If different than above) <br /> Alternate County: <br /> Alternate State: <br /> Alternate Zip: <br /> Alternate Zip Plus: <br /> Alternate Country: <br /> Signature of PAPERS User: DATE: 101(n <br /> (Consultant or local government PAPRS ser) <br /> Signature of Local Government C O DATE: 1/21/03 <br /> Kenneth R. Macht,_ Chailvrman <br /> DCA USE ONLY: I approve this individual for PAPERS and the Enterprise Information System: <br /> Colleen Matthews Date <br /> Libby Lane Date <br /> Steve Grantham/Terresa Grosvenor Date <br /> Comments: <br />