U.S. DEPARTMENT OF AGRICULTURE APPLICATION FOR FEDERAL ASSISTANCE (For Non-Construction) Prat? Standard Form 424.1 (Rev. 7-97)Copy now fayuw APPLICATION FOR OMB Approval No 03480045, FEDERAL ASSISTANCE = ORTE SUBMITTED ookean aerier bi aio Fc TYRE OF SuBNiSSION: Is OATE RECEIVED BY STATE [Sate Arpicton enter cation lPreoptiston ‘Consructon [construction _ | DATE REGEIVED BY FEDERAL AGENCY |Fodoal ctr [ilnon-constrcton |] Non-Constuction I APPLICANT INFORMATION Lega ame a" orgerigatonal ors meutcells, AT City of montice ifo [sree ec oun, Ste and caer Name and tlphone nba of person i be cola on mato wah Po Bote? igapetcton ave ae ce Fo @ ; eres me Monticel gh 8493 | bay. 227t [EMPLOYER IDENTIFICATION NUMBER (ENT iP oF APBLGANT ora Er Ba) — —[efore[o [21 Elo Fela) sIe] Asse Hintpoaont scoot, — la: TYPE OF APPLICATION: 8 couny 1 State Conta eben of Hohe Lesring Now Continuation Revision C.Municipal J. Private University Eve O o D.Township Kinane If Revision, enter appropriate letter(s) in box(es) oO oO E. Interstate. L Individual F ntermunipal_—M. Pott Organizalon Alrwase Avard 8, Decrease Avard ©. crease Durabon G Spec Diet N. Ofer (Spec) D.Decresee uration Oherspeci [NAME OF FEDERAL AGENCY: U.S. Departacut of Raviceiiwe Fo: ATG OF FEDERAL DOMESTIC ASSSTANCEKONER 11, DESCRIPTIVE TITLE OF APPLIGANTSS PROJECT? af LP |—(71 14 . me BEG Lind Resource Assesenent Fa: AREAS AFFECTED BY PROJECT (Cite, Contes, Sata : a eee eres setae wl Bean bility Stucly tity orice lle, San ius Come Fi PROPOSED PROJEGT [14 CONGRESSIONAL DISTRICTS OF [Sar bate —Enarg One |o Apricot 7 p-Proee i Uta a Pai Aud Fis: ESTAATED FUNDING? 16:18 APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE (ORDER 12372 PROCESS? a Feder = * LY oF? {2 YES, THIS PREAPPLICATION(APPLICATION WAS MADE prone = [AVAILABLE TO THE STATE EXECUTIVE ORDER 12572 PROCESS FOR REVIEW ON = Site U ae eeacl ovre_b sot lator = No, [J PROGRAMIS NOT COVERED BYE. 0.12972 je Oar = lon PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW |*. Program income s = . 17.18 THE APPLICANT DELINGUENT ON ANY FEDERAL DEBT? [a TOTAL 5 LG.see [yes ives,” attach an explanation. Ha: TO THE BEST OF mv KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE [ATTACHED ASSURANCES IF THE ASSISTANCE 15 AWARDED. a Tipe Name of Aherized Represeriave bie lz Teephene Nomar la Signore ot Ahan Represent e-bate Sane Prevous Eien Uae Siandard Form 4 Ren TOT) ‘Aunrizacs er Local Reproduction Prescribed by OMB Creular A102