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Page 2 <br />CDBG Request Form <br />City of Rarnsey <br />Name of Organization <br /> <br />the <br /> <br /> Does your organization serve low to moderate income families or individuals? If you answer no, <br /> your organization is not eligible to receive CDBG funds. <br /> <br /> _ X Yes No <br /> <br /> What percentage of persons served are low/moderate income individuals? <br /> <br /> ~ 0 -% <br /> <br /> What percentage of low/moderate income persons served are Ramsey residents? <br /> <br /> 't,~. % <br /> <br />Will these funds be used for an expansion of an existing program? <br /> <br /> PZsabZ£Z~,tt X Yes No <br /> C~e.a/t. ino House Zs ne.w <br />Will these funds be used for the creation of a new program? <br /> <br /> P~*±; ~ -e e,yes No <br /> <br />PLEASE PROVDE THE FOLLOWING INFORMATION WITH YOUR APPLICATION: <br />ene£o.~ed 1997 organization budget <br /> <br />.~ 1.00 0.0 Q Proposed budget for CDBG funds <br /> <br /> : - 9 g ; ? - 9 ~chedule for expenditure of CDBG funds <br /> <br />F. x. a4/,. Name of individual(s) authorized to receive CDBG reimbursement checks <br />.... o .... 28oS~%f4he ~i~s~ 5~o~es of i~oo~poration <br /> <br /> I <br /> <br /> I <br />I <br /> I <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />I <br />I <br /> <br /> <br />