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APPLICATION FOR Version 7/03 <br /> 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 /> H I Construction ❑ Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> Non-Construction El Non -Construction <br /> 5. APPLICANT INFORMATION <br /> Legal Name : Organizational Unit: <br /> INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS Department: <br /> Organizational DUNS : Division : <br /> 59-6000-674 <br /> Address : Name and telephone number of person to be contacted on matters <br /> Street: involving this application (give area code) <br /> Prefix : First Name : <br /> 1840 25TH STREET JASON <br /> City' Middle Name <br /> VERO BEACH , FL <br /> County: Last Name <br /> COUNTY BROWN <br /> State : Zip Code Suffix : <br /> FLORIDA 32960 BUDGET DIRECTOR <br /> Country: Email : <br /> 6. EMPLOYER IDENTIFICATION NUMBER (E/N): Phone Number (give area code) Fax Number (give area code) <br /> 5❑ Y _© Ka 0❑ © 7❑ ® 772-567-8000 772-567-5991 <br /> 8. TYPE OF APPLICATION : 7. TYPE OF APPLICANT: (See back of form for Application Types) <br /> IF New F1 Continuation Revision B <br /> If Revision , enter appropriate letter(s) in box(es) <br /> (See back of form for description of letters .) ❑ ❑ her (specify) <br /> Other (specify) 9. NAME OF FEDERAL AGENCY: <br /> 10 . CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11 . DESCRIPTIVE TITLE OF APPLICANTS PROJECT: <br /> n: — i [ 5❑ TRANSITIONAL HOUSING ONE YEAR RENEWAL <br /> TITLE (Name of Program) : <br /> 12 . AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): <br /> 13 . PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF : <br /> Start Date: Ending Date : a . Applicant b. Project <br /> 08/01 /2006 07/01 /2007 15 5 <br /> 15. ESTIMATED FUNDING : 16 . IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br /> ORDER 12372 PROCESS? <br /> a . FederalYes. �Q THIS PREAPPLICATION /APPLICATION WAS MADE <br /> a . <br /> 24 ,581 .00 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 $ OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br /> 6 , 145.25 FOR REVIEW <br /> f. Program Income UU 17 . IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> g . TOTAL ❑ Yes If "Yes" attach an explanation . No <br /> 30 ,726 .25 <br /> 18 . TO THE BEST OF MY KNOWLEDGE AND BELIEF , ALL DATA IN THIS APPLICATION/P EAPPLICATION 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 /> aap. Authorized Representative <br /> CF1&MAN <br /> First Name <br /> fiddle Name <br /> S . <br /> Last Name Suffix <br /> LOWTHER <br /> b. Title c. Telephone Number _ , a e ode) <br /> CHAIR, BOARD OF COUNTY COMMISSIONERS 772M� (MK 2b - � 06 <br /> Signature of Authorized Representative . Date Si ned <br /> Signature May 7 , 2005 <br /> Previous Edition Usable Standard Form 424 (Rev.9-2003) <br /> Authorized for Local Reproduction Prescribed by OMB Circular A- 102 <br />