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LATE <br /> <br />AGENCY INFORMATION 2/16/2018 1:09:05 PM Page 8 of 20 <br /> <br />1. COVER PAGE <br /> <br />a) Applicant Contact Information <br /> <br />Applicant Organization’s Legal Name: Farmer Foodshare <br /> <br />Applicant Organization’s Physical Address: 902 N. Mangum Street, Durham, NC 27701 <br /> <br />Applicant Organization’s Mailing Address: P.O. Box 2873, Chapel Hill, NC 27515 <br /> <br />Applicant Organization’s Web Address: www.farmerfoodshare.org <br /> <br />Executive Director: Gini Bell <br /> <br />Telephone Number: 919.360.6358 E-Mail: gini@farmerfoodshare.org <br /> <br />Tax ID Number: 27-3717889 <br /> <br />b) Funding Request <br />List all FY18-19 Human Services (HS) Funding Being Requested – <br />For All Programs) and the Proposed Use of Funds (2-3 lines or less) <br /> <br />Program Carrboro <br />- HS <br />Chapel <br />Hill - HS <br />Orange <br />County-HS <br />Total <br />Donation Station Program – Farmers market- <br />based program that supports local Orange <br />County farmers and organizations working to <br />increase access to fresh food to community <br />members in need. <br />$5,000 $5,000 $10,000 $20,000 <br />Totals $5,000 $5,000 $10,000 $20,000 <br /> <br /> <br />c) To the best of my knowledge and belief all information and data in this application is <br />true and current. The document has been duly authorized by the governing board of the <br />applicant. <br /> <br /> <br />Signature: <br /> 1/23/2018 <br /> Executive Director Date <br /> <br /> <br />Signature: <br /> 1/23/2018 <br /> Board Chairperson Date <br />