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Attachment A <br />Cabarrus County Parks Department <br />P.O. Box 707, Concord, NC 28026 -0707 <br />ATCHING INCENTIVE GRANT APPLICANT <br />INFORMATION FORM <br />1. APPLICANT INFORMATION <br />ORGANIZATION NAME <br />NON-PROFIT <br />C 'v � / . r , -- u ;-r T & <br />V YES NO <br />ADDRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />;} ,3<— I�,icvev- <br />PROJECT C ORDINATOR'SNAME <br />EMAIL ADDRESS <br />ADDRESS <br />al C "= e <br />PHONE NUMBER <br />FAXNUMBER <br />OTHER NUMBER <br />A&7) <br />SCHOOL PRINCIPAL'S NAME (IF PROJECT LOCATED ON SCHOOL PROPERTY) <br />EMAILADDRESS <br />ADDRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHERNUMBER <br />2. PROJECT INFORMATION <br />DESCRIPTIVE TITLE OF PROJECT <br />5 kacfe .��el ier Vo, V a el a <br />PROJECT SITE <br />efi g,,A CA <br />STRI ET ADD ESS <br />CITY <br />STATE <br />ZIPCODE <br />I° ogq c& <br />iv <br />a � <br />v � � 3�1 <br />AREAS AFFECTED BY PROJECT: <br />f <br />(SCHOOLS, MUNICIPALITIES, ETC.) <br />NEW PROJECT <br />START DATE <br />ON -GOING PROJECT <br />COMPLETION DATE <br />WILL A FEE BE CHARGED FOR USE <br />ON -GOING MAINTENANCE FOR PROJECT WILL BE PROVIDED BY: <br />OF FACILITYIPROJECT ? <br />o P <br />'/ NO <br />YES <br />ESTIMATED FUNDING: <br />TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION IS TRUE AND CORRECT. THE <br />�ssT 7 <br />DOCUMENT HAS BEEN AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL <br />APPLICANT $ � <br />COMPLY WITH THE ATTACHED ASSURANCES IF THE GRANT IS AWARDED. <br />COUNTY $ 4 so <br />TYPED NAME OF PROJECT COOR <br />IN -KIND $ <br />TOTAL $ '`116 <br />SIGNATURE OF JECT COORDI TO <br />10 <br />F -7 <br />Attachment number 2 <br />Page 144 <br />