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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:
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| _________________________ | $____________________ | ||
| 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.
| _____________________________________ Signature |
___________________ Date | |
| _____________________________________ Signature |
___________________ Date |