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Page 2 <br />CDBG Request Form <br />City of Ramsey <br />Name of Organization <br /> <br />Alexandra House, Inc.. <br /> <br /> Does your organization serve low to moderate income families or individuals? If your <br /> answer is no, your organization is not eligible to receive CDBG funds. <br /> <br /> XX Yes No <br /> <br />What percentage of persons served are low/moderate income individuals? <br /> <br /> 9O % <br /> <br />What percentage of low/moderate income persons served are Ramsey residents7 <br /> <br /> 10 % <br /> <br />Will these funds be used for an expansion of an existing program? <br /> <br /> Yes XX No <br /> <br />Will these funds be used for the creation of an existing program? <br /> <br /> Yes XX No <br /> <br />PLEASE PROVIDE THE FOLLOWING INFORMATION WITH YOUR APPLICATION: <br /> <br /> XX 1998 organization budget <br /> XX Proposed budget for CDBG funds <br /> XX Schedule for expenditure of CDBG funds (Please see 1998 Per Diem budget) <br /> XX Name of individual (s) authorized to receive CDBG reimbursement checks <br /> <br /> XX A copy of the organization's articles of incorporation ~ <br /> <br /> <br />