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Application Exhibit B <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name:The 23"Mildred Council Annual Community Dinner <br /> Applicant Organization's Physical Address: 1615wansea Lane,Chapel Hill,N.C.27516 <br /> Applicant Organization's Mailing Address: 161, Swansea Lane, Chapel Hill, N.0 27516 <br /> Applicant Organization's Web Address:communitydinner.org <br /> Executive ❑irector: Nerys Levy <br /> Telephone Number: 919-932-1533 E-Mail: rilevvflmindspring.com <br /> Tax I❑ Number:56-6000327 (Orange County) <br /> Funding Request <br /> Please list all Fiscal Year 2020 Human Services[HS]funding requested for all programs and the <br /> proposed use of funds (please list program name only) <br /> Program Carrboro- Chapel Orange Total <br /> HS Hill-HS County-HS <br /> .23'd Mildred Council Annual Community Dinner $1000 $1000 <br /> Totals $1000 $1000 <br /> To the best of my knowledge and belief all information and data in this application is true and <br /> current. The document has been duly authorized by the governing board of the applicant. <br /> Signature: Nerys W Levy—electronically signed January 17 2019 <br /> Executive ❑irector ❑ate <br /> Signature: Nerys w.Levy-electronically signed January 17`"2019 <br /> Board Chairperson Date <br /> Cover Page P a €, e 1 n f 7 <br />