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Altachmenl A <br />Cabarrus County Parks Department <br />P.O. Box 707, Concord, NC 28026 -0707 <br />MATCHING INCENTIVE GRANT APPLI <br />INFORMATION FORM <br />1. APPLICANT INFORMATION <br />ORGANIZATION NAME <br />r� � o <br />NON-PROFIT <br />z YES <br />l�1/edd tiva IS <br />ADDRESS <br />PH�(�UR4 <br />t� <br />I <br />`, ' <br />f�/�1 tiler n <br />^C � <br />7 <br />� <br />7 <br />L 4 - ) ; � ! <br />PROJECT COORDINATOR'S NAM <br />'e /UO te1 !1. j_o Aj <br />EMAIL ADDRESS t <br />4 <br />ADDRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />SCHOOL PRINCIPAL'S NAME (IF PROJECT LOCATED ON SCHOOL PROPER r `; '•, <br />Eh9AILADORESS f �: r_ Cv1 C b�r��LLf r r �� � l(s <br />ADDRESS It <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUh9BER <br />I to Ll °7 `tads` <br />°`( 1 l� `l'3 <br />2. PROJECT INFORMATION <br />DESCRIPT$VETITLE OF PROJECT <br />PROJECT SITE <br />JW edd ln 2 1 Ala k /C Tres f � <br />STREETADDRESS <br />CITY <br />STATE <br />ZIPCODE <br />,, d <br />�q#j Wed kd. <br />Olonai <br />C? d��7 <br />AREAS AFFECTED BY PROJECT: <br />(SCHOOLS, MUNICIPALITIES, ETC.) <br />NEW P ROJECT <br />1 <br />START DATE 1 <br />y ef I(,E � �R� <br />d �n <br />� ON-GOING PROJECT <br />COMPLETION DATE <br />+ n <br />i <br />WILL A FEE BE CH OED FOR USE <br />ONGOING MAINTENANCE FOR PROJECT WILL BE PROVIDED BY: <br />OF FACTITYlPROJECT? <br />YES -_� NO <br />ESTIMATED FUNDING; <br />TO THE BEST OF h9Y KNOW EOGE AND BELIEF, ALL DATA IN THIS APPLICATION IS TRUE AND CORRECT. THE <br />U ) 0,06 <br />DOCUh9ENT HAS BEEN AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL <br />APPLICANT S l t✓ <br />COMPLY WITH THE ATTACHED ASSURANCES IF THE GRANT IS AWARDED. <br />COUNTY S !�� 0 �N3 <br />TYPED NAME OF PROJECT COORDINATOR / <br />e- n o r 4' Is a j•r 45 Al <br />IN-KIND S <br />/+ <br />TOT S <br />SIGNATUYQF OJE CT COORDINATOR <br />10 <br />Z' <br />Attachment number 1 <br />F -7 Page 140 <br />