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Facade Improvement Program Grant Application

 

Lake County Facade Improvement Program Grant Application 

 

1. Applicant Name: ___________________________________________
    Name of Business: ___________________________________________
            Sole Proprietorship: __________ S Corporation: __________

Partnership: __________ C Corporation: __________



LLC/LLP: __________
     Business Telephone:    _______________
     Home Telephone:         _______________
     Fax:                                 _______________

     Street Address: ____________________ City _______________ Zip __________

Mailing Address: ____________________ City _______________ Zip __________

  
       Assessor's Parcel Number:_________________

2.  Grant Amount Requested:  $________________

       Uses of Funds:

                 _________________________            $____________________

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               Total
$____________________



3.  Ownership:  All owners of 20% or more of the applicant business are listed below:

     Name ________________________________________

Home Address ________________________________________

City, State, Zip, Phone ________________________________________

% of Ownership ________________________________________

     Name ________________________________________

Home Address ________________________________________

City, State, Zip, Phone ________________________________________

% of Ownership ________________________________________

(If additional space is needed, please use reverse side of this page.)


History of Business

Describe the business, how it was acquired by you, and how long you have owned it. 
Discuss any significant events that have affected the business' development.

 

 

 

 

 

 

 

 

 

 

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Description of Project

Explain what will change with the receipt of these grant funds.  Cover such items as how the funds will be used, changes in operations, future plans, need for additional employees, changes inincome, expenses, competitive advantages, etc.  Attach any and all architecutral drawings at the end of this document.

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APPLICANT'S CERTIFICATION/AUTHORIZATION

I/We certify that all information in this application and all information furnished in support of this application are true and complete to the best of my/our knowledge and belief.

I/We certify that Iwe have read and understand the Facade Improvement Program Rules and Guidelines and will abide by them.

I/We also acknowledge that this is an application for public funds and, therefore, the information provided may be made available for review.

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Signature
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Date
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Signature

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Date