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FEDERAL ASSISTANCE <br />2. APPLI• a. NUMBER 3- STATE a. NUMBER <br />CANTS APPLI- <br />APPLI- NONE CATION <br />CATION IDENTI- <br />IDENTI• b BATE FIER b. DATE <br />FIER Year .,,,,,w Jay NOTE: TO BE ASSIGNED <br />ASSIGNED <br />19 9 0-05- 0 11 BY STATE <br />Uour <br />Blank <br />19 <br />Year rawtA Jay <br />4. LEGAL APPLICANT/RECIPIENT <br />1. TYPE <br />0 NOTICE OF INTENT <br />S6- <br />SUBMISSION <br />(OPTIONAL) <br />War* op <br />l7 PREAPPLICATION <br />a. NUMBER <br />12 1 J 4011 <br />bug <br />10- APPLICATION <br />2. APPLI• a. NUMBER 3- STATE a. NUMBER <br />CANTS APPLI- <br />APPLI- NONE CATION <br />CATION IDENTI- <br />IDENTI• b BATE FIER b. DATE <br />FIER Year .,,,,,w Jay NOTE: TO BE ASSIGNED <br />ASSIGNED <br />19 9 0-05- 0 11 BY STATE <br />Uour <br />Blank <br />19 <br />Year rawtA Jay <br />4. LEGAL APPLICANT/RECIPIENT <br />5. EMPLOYER IDENTIFICATION NUMbt ;x(LIN) <br />a. Applicant Name ORANGE COUNTY <br />S6- <br />nnnI97 <br />ktlantaf Ga. 30303 <br />b. Organization Unit :County Government <br />6• <br />PRO- <br />a. NUMBER <br />12 1 J 4011 <br />c. Street/P.O. Box P •. O .BOX 8181 <br />GRAM <br />DATE <br />d. City H i 11 sbo roug h County Orange <br />- <br />G THAT m- plieant and the applipnt will comply with <br />rioeC& die"'"°°"Jt"°°"'ten"" <br />f. State N.C. g. ZIP Code. 27278 <br />rF,um OVA) <br />MULTIPLE Q <br />e <br />h. Contact Person #Name Terri Tyson, RSVP Director <br />OR <br />b. TITLE <br />Retired Senior <br />b. SIGNATURE <br />o CERTIFYING <br />Volunteer Pro ram <br />ATriclAoneNO -) _ <br />7. TITLE OF APPLICANTS PROJECT (Use section IV. of this form to provide a.summary <br />A. TYPE OF APPLICANT/RECIPIENT <br />a description of the project. <br />orange County - Chapel Hill - Retired <br />A�tAa <br />�,, „� <br />G• Special Punove District <br />H-Co munAy Action Agency <br />t„I <br />Senior Volunteer Program.The project provides <br />C- 5ustilote <br />Organ „��rt <br />1- Ihgher Gduc.twwwl Inuiwlwn <br />J_IndianTetbe <br />the means by which an individual aged 60 or <br />E- my <br />K- Otherrsprdihr. K <br />Z I or older may serve the community as a v o l u n t e e <br />- chow Din^ct Enter appropriate letter <br />9. AREA OF PROJECT IMPACT uv-m a/rifw& awnar., "aim ♦ru <br />F Orange County, North Carolina <br />W <br />12. PROPOSED FUNDING <br />10. ESTIMATED NO. OF 11. TYPE OF ASSISI'ANUtr <br />PERSONSSQ BENEFITING A -Basic Grand D- Irwurar� <br />N <br />B- Suapleawnlal Grant 1,(Xher <br />C -l.rn Enter Awmwwtr lertens) <br />13, CONGRESSIONAL DISTRICT OF: <br />a. FEDERAL $ 10 , 081 '00 I a. APPLICANT <br />b. APPLICANT .00 Fourth <br />c. STATE .00 15. PROJECT START <br />d. LOCAL 00 DATE Year month day <br />19 90-07- <br />e. OTHER .00 <br />18. DATE DUE TO <br />f. Total $ 10,081 -00 FEDERAL AGENCY <br />19. FEDERAL AGENCY TO RECEIVE REQUEST <br />a. ORGANIZATIONAL UNIT (LF APPROPRIATE) b. <br />b.PROJECT <br />Fourth <br />16. PROJECT <br />DURATION <br />L 12 month. <br />rror month day <br />14. TYPE OF APPLICATION <br />A -New C- Revision E- Augmentation <br />B- Renewal D- Gmunuation <br />Enter appropriate letter K <br />17, TYPE OF CHANGE rF'w 044, w 14rl <br />A- Increase Dollars F -Ulher lspmjyl <br />B- Deera,ae Dollars <br />C -Inca Duration <br />D -0acre Duration <br />E-Cancellati on <br />Enter apps. � I <br />priate lenM.t �J <br />20. EXISTING FEDERAL <br />GRANT ]DENT. NO. <br />440 - 4768/08 <br />21. REMARKS ADDED <br />c. ADpR <br />101 Marietta Street, N.W. Yes MV No <br />ktlantaf Ga. 30303 <br />YES, THIS NOTICE OF INTENT/PREAPPLI CATION /APPLICATION WAS MADE AVAILABLE <br />p 22. To the bag d my knuwlvgtir and belief, dart <br />F THE in this preapplia tiaNapplication are true <br />a. <br />TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: <br />APPLICANT and ��ec4 the documem has been duly <br />DATE <br />CERTIFIES ,uthorirad by the governing body d the sp. <br />- <br />G THAT m- plieant and the applipnt will comply with <br />rioeC& die"'"°°"Jt"°°"'ten"" <br />.. <br />b, NO, PROGRAM IS NOT COVERED BY E.O. 12372 0 <br />'pproved <br />ate <br />PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 0 <br />OR <br />23. a. TYPED NAME AND TITLE <br />b. SIGNATURE <br />o CERTIFYING <br />REPRE- Moses Carey, <br />Chair e <br />SENTATIVE <br />24. APPLICA- Yrar aamth day <br />r" Ka 9AIP PUTIC ATI N IDENT. NO. 26. FEDERAL GRAN TIFICATION <br />TION <br />RECENED 19 <br />27. ACTION TAKEN 28. FUNDING Year Imam dar 30. Yaw matdA dote <br />11VG <br />I ; ■. AWARDED <br />29. ACTON DATE- 19 DATE 19 <br />b. REJECTED <br />pOE c. RRIURNF:D FOR a. FEDERAL 3 <br />.00 31. CONTACT FOR ADDITIONAL 32. Yemr mwrh date <br />ENDING <br />AMENDMENT <br />b. APPLICANT <br />INFORMATION m rNome and Aei PNnrr brrO <br />DATE 19 <br />wt I I d. RE URNED FOR <br />o- E.D. t'1372 SUMMON <br />c. STATE <br />.00 <br />•00 33. REMARKS ADDED <br />zz BY APPUCANTTO <br />Dv STATE d. LOCAL <br />•00 <br />5� . ; e. DEFERRED <br />f. WMIURAWN e.OTHER <br />OO <br />Yes No <br />m <br />f. Tout)' $ <br />.00 <br />PAGE 1 <br />Prncntwd by OMB Circalar A•102 <br />a <br />' r <br />