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APPLICATION FORVersion 7/03 <br /> Y FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier <br /> 1 . TYPE OF SUBMISSION : 3. DATE RECEIVED BY STATE State Application Identifier <br /> Application Pre-application <br /> ConstructionConstruction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> Non-Construction ❑ Non -Construction <br /> 5. APPLICANT INFORMATION <br /> Legal Name : Organizational Unit: <br /> INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS Department: <br /> COUNTY GOVERNMENT <br /> Organizational DUNS : Division : <br /> 079-208-989 <br /> Address : Name and telephone number of person to be contacted on matters <br /> Street: involving this application (give area code) <br /> 184025TH STREET Prefix . First Name : <br /> JASON <br /> Cityy: Middle Name <br /> VERO BEACH <br /> County: Last Name <br /> INDIAN RIVER BROWN <br /> State : Zip Code Suffix : <br /> FLORIDA 32960 BUDGET DIRECTOR <br /> Country: Email : <br /> UNITED STATES JBROWN@IRCGOV . COM <br /> 6. EMPLOYER IDENTIFICATION NUMBER (EIN) : Phone Number (give area code) Fax Number (give area code) <br /> MKKE 0❑ © E ® 772-567-8000 772-567-5991 <br /> B. TYPE OF APPLICATION : 7. TYPE OF APPLICANT : (See back of form for Application Types ) <br /> V New F1 Continuation [7 Revision B <br /> If Revision , enter appropriate letter(s ) in box( es ) <br /> (See back of form for description of letters . ) ❑ ❑ Other ( specify ) <br /> Other (specify) 9. NAME OF FEDERAL AGENCY : <br /> US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT <br /> 10 . CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER : 11 . DESCRIPTIVE TITLE OF APPLICANT' S PROJECT : <br /> o ® - oao S +C TENANT RENTAL ASSISTANCE <br /> TITLE ( Name of Program ): <br /> CONTINUUM OF CARE HOMELESS ASSISTANCE - SHELTER PLUS CARE <br /> 12. AREAS AFFECTED BY PROJECT (Cities , Counties, States. etc.) : <br /> INDIAN RIVER COUNTY , FLORIDA <br /> 13 . PROPOSED PROJECT 14 . CONGRESSIONAL DISTRICTS OF : <br /> Start Date: Ending Date : a . Applicant b . Project <br /> 5/01 /2006 4/30/2011 fs <br /> 15. ESTIMATED FUNDING : 16 . IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br /> ORDER 12372 PROCESS ? <br /> a . Federal THIS PREAPPLICATIONIAPPLICATION WAS MADE <br /> 355 , 080 . 00 a . Yes . AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 <br /> b . Applicant PROCESS FOR REVIEW ON <br /> c. State DATE : <br /> d . Local b . No . PROGRAM IS NOT COVERED BY E . O . 12372 <br /> e . Other n OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br /> 355 , 080 . 00 FOR REVIEW <br /> f. Program Income 17 . IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> g . TOTAL <br /> 710 , 160 . 00 ❑ Yes If "Yes" attach an explanation . _ No <br /> 18 . TO THE BEST OF MY KNOWLEDGE AND BELIEF , ALL DATA IN THIS APPLICATION /PREAPPLICATION ARE TRUE AND CORRECT. THE <br /> DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br /> ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED . <br /> a . Authorized Representative <br /> C�(AIRMAN THOMASe Middle Name <br /> Last Name Suffix <br /> LOWTHER <br /> b . Title c . Telephone Number (give area code) <br /> CHAIR , BOARD OF C UNTY COM SSIONERS 772 — <br /> Signatur Author ed I�� e t e . Daate Si n d 200 <br /> Previous Edition Usable Standard Form 424 ( Rev . 9-2003) <br /> Authorized for Local Reoroduction Prescribed by OMB Circular A- 102 <br />