Laserfiche WebLink
L AHaclwntA <br />Cabarrus County Parks Department <br />P.O. Box 707, Concord, NC 28026 -0707 <br />MATCHING INCENTIVE GRANT APPLICANT <br />INFORMATION FORM <br />1. APPLICANT INFORMATION <br />ORGANIZATION NAME <br />NON - PROFIT <br />/{ r /`f��Gr4��/t71�11a1 ci JG�uD! <br />✓ YES NO <br />ADDRESS <br />3`1.3 4Y6 ;/ne foe <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />. <br />C4nca4 z -rw 2 s <br />7 0y S - k -2187 <br />71 Y- 7k.7 o6 <br />PROJECT COORDINATOR'S NAME <br />a <br />E IL ADDRESS <br />AD D R [8 S <br />#4F 2 5 Udf <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUMBER <br />one ohd 1 N L 24- o2_6' <br />70 q —2 6 Z - 6 2 3S <br />70 4 1 - <br />7 6 76 <br />SC 10 L PRINCIPAL'S NAME (IF PROJECT LOCATED ON SCHOOL PROPERTY) <br />S <br />E I ADDRESS <br />Y s. 12, c. U 4 <br />ADDRESS <br />393 9 A Men e Ad <br />PHONE NUMBER <br />FAX NUMBER <br />OTHER NUWER <br />0044"P j /1-4 z9ozs <br />70z/" 2 /a'1 <br />7 -78s -Ob S <br />70 '7&q S�k <br />2. PROJECT INFORMATION <br />DESCRIPTIVE TITLE OF PROJECT <br />r� <br />1/ rA c le - COI'I cret wotl k iN -'yv cK <br />PROJ SITE <br />4, i Mlle- � �e Meng r Schu1 I <br />STREET ADDR SS <br />3?39 ,(7��c`te I�cl <br />CITY <br />�UnGOrr� <br />STATE <br />Alc <br />ZIPCODE <br />Z X025 <br />Concord , Ne, 2 ire l - C <br />AREAS AFFECTED BY PROJECT: <br />(SCHOOLS, MUNICIPALITIES, ETC.) <br />A NEW PROJECT <br />START DATE 1 20 � <br />JGh va f <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 />� <br />ea�arru r � w,,. �c11 odds F c ,-/.1,rs a..4 0 Y, <br />YES NO <br />ESTIMATED FUNDING: <br />TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION IS TRUE AND CORRECT. THE <br />/� <br />DOCUMENT HAS BEEN AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL <br />APPLICANT $ 7 j QQ d <br />COMPLY WITH THE ATTACHED ASSURANCES IF THE GRANT IS AWARDED. <br />COUNTY $ 11000 <br />T NAME OF PROJECT COORDINATOR <br />IN -KIND $ <br />70 hn Owen h y <br />TOTAL $ fig 6410 <br />SIGNAT RE OF P JECT ORDIN� <br />of ref <br />e <br />110] <br />Attachment number 4 <br />F -7 Page 150 <br />