APPLICATION OF FUNDING

APPLICATION OF FUNDING
Name of organization, group, or entity requesting funds:
Total amount of funding required:
3. Does applicant agree to provide most recent budget or tax statement?
Does applicant agree to provide most recent budget or tax statement?

YESNO
PLEASE ATTACH

Cancelof
4. Amount of funding sought from City of St. Matthews
5. Specific description of how the funds will be utilized
6. Has the City of St Matthews provided funding for any purposes, within the past two (2) years?

YESNO
If Yes, provide details
The undersigned, the authorized officer or agent of
hereby certifies that
is not a for-profit entity, that the proceeds of any disbursement from the City will be used solely for the purposes set forth herein,
and further that
any person or entity on the basis of race, color, religion, sex, or national origin.
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Print Name
Date

MonthDayYear
Date
Complete return mailing address:
No./Street
City
State
Zip
Phone (Day)
Phone (Night)
Should be Empty: