Hotel/Motel Tax Grant Application

Hotel/Motel Tax Grant Application
Applicant Information
Organization Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of the event/project
Date of the event/project, if applicable

MonthDayYear
Date
Location of the event/project
Event/project contact person

First NameLast Name
Contact's email address
example@example.com
Contact's phone number
Please enter a valid phone number.Format: (000) 000-0000.
Federal ID number
Have you received a Hotel/Motel Tax Grant in the past?
Please list the years and projects you have received a Hotel/Motel Tax Grant.
Does your organization receive funding from the City of Dublin through another venue?
Please identify other City of Dublin funding the organization receives.
How many years has the event/project occurred in Dublin?

Event/Project Information
Please provide a brief description of the event/project.
Please describe how the City of Dublin's support will be recognized.
What City services (Police, street Maintenance and Repairs, Parks and Ground Maintenance, etc.) are required to implement the event/project?
Please describe how this event/project enhances resident quality of life and supports the City's goal of being a safe, resilient and inclusive community.
Is the event/project free for the public to view/attend?
If not, what is the cost for admission?
Will there be alcohol sales?

Funding Information
Grand amount requested.
Total event/project budget.
Please list all funding sources, aside from this grant, that the organization plans to leverage. Please identify all funding sources that are confirmed at the time of submitting this application.
Please attach an itemized list of each expenditure the grant request will be used for. This list should be specific to each expense the grant funds will cover. Funds not included in this application will not be eligible for reimbursement. The total expenditures listed should match the grant amount requested. It should read as Expenditure - Amount. For example:City Services - $600

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Attachments
A copy of the Treasury letter certifying tax-exempt status as an organization that is not a private foundation.

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A copy of the organizations most recent W9.

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A copy of the organization's most recent Form 990.

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Certification
Submission of this application does not guarantee availability or permission to use a public area. Please contact Community Events at 614-410-4545 to check venue availability and apply for any necessary permits.
I understand the organization will be reimbursed by the City of Dublin upon satisfactory completion of the event/project. To receive reimbursement, I understand that I will be required to submit a final report, original documents and receipts. No reimbursements will be made by the City without completion of the event/project and appropriate documentation and full payment of City services.
Applicant name

First NameLast Name
Applicant signature
Should be Empty: