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Cabarrus County Parks Department Agadxnent A <br />P.O. Rox 707, Concord, NC 28026 -0707 <br />TCHING INCENTIVE GRANT APPLICANT <br />INFORMATION FORM <br />T,'.5MA0,1 <br />1. APPLICANT INFORMATION <br />ORGANIZATION NAME <br />NON- PROFIT <br />"} i ^� <br />t aka - kDTS Flery - wnkaf 1 I /� <br />Ll" YES NO <br />ADDRESS <br />PHONE NYMBER <br />FAX NUMBER <br />OTHER NUMBER <br />S k? " U 1 cu n Kwflvk <br />C_Dncor me 8k..$�d4lt5 <br />'�p'�- L-SS- I�$',L <br />r 55 l$43{0 <br />10 Cv_S� <br />PROJECT COORDI TOR' NAME <br />Phi 11', u1 <br />EMAILADD SS <br />( PC _ a 6af_(kAr,, <br />DRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />IS 1 b &�6k& -N Nver u-C- <br />cL„�r�rrl, luc L4�zuas <br />'coq- qss- <br />- 1oA - Ll G's IK 7�v <br />^G�(3 PRINCIPAL'S E OF PROJECT LOCATED ON SCHOOL PROPERTY) <br />s 1 1l1 D A <br />EMAIL ADD SS <br />ki !i A !k CCl LAC S <br />ADDRESS <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />151v 1{old n A uer, u� <br />Cnv,cord <br />`�S`a k`6i3_ <br />�7a`'I`NSr - 3 - kgv ty <br />2. PROJECT INFORMATION <br />DESCRIPTIVE TITLE OF PROJECT <br />Rack C�tbL c� <br />PROJECT SITE <br />STREETADDRESS <br />CITY <br />STATE <br />ZIPCODE <br />A <br />k510 1�Q�C1�Y1 kw v e- <br />CO3\Cb <br />MC <br />c -PY,crw4l, WC axoL16 <br />AREAS AFFECTED BY PROJECT: <br />(SCHOOLS, MUNICIPALITIES, ETC.) <br />NEW PROJECT <br />START DATE Sa r,rtcr 0.o t E <br />F r�l�en�r��c�� - � ��- c- 1-,a�l <br />ON- GOINGPROJECT <br />COMPLETIONDATE Sur..wr7l <br />WILL A FEE BE CHARGED FOR USE <br />ON -GOING MAINTENANCE PROJECT WLL BE PROVIDED BY: <br />OF FACILITYIPROJECT? <br />YES ✓ NO <br />�akjC.tr(tAS O_OLAr`t[ Sc_kbots <br />ESTIMATED FUNDING: <br />TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION IS TRUE AND CORRECT. THE <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 $ 3�$ia.1i> <br />TYPED NAME OF PROJECT COORDINATOR <br />IN-KIND $-O- Les <br />TOTAL $ `7, b'�' C� <br />SIG URE F PROJECT CQORDIRATOR <br />v <br />F -7 <br />10 <br />Attachment number 3 <br />Page 147 <br />