Mayor Grant Suits for Seniors0
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EXHIBIT "A"
E
COMMUNITY SUPPORT FUNDS
REQUEST FORM
Part I - Summary of Request (to be completed by City Clerk)
Date of Request:
R15-055
Requested by Mayor/Commissioner: o•uor S e B , �-rzh (-
Amount Requested: $ 910 0,
Recipient/Payee: 5,', ;..-
Desclripfip of project, program, or activity to be funded:
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Part II - Availability of funds
The annual appropriation of funds available to the requesting Member of the
Commission listed above is $
The balance f funds available for the requesting Member of the Commission is
Accordingly:
There are funds available as requested
There are insufficient funds available as requested
Dated: < ' By: L�
/City Clerk
Part III -Eligibility Evaluation
Public funds will not be used to improve private property unless there is a clear
public need, purpose and benefit
The recipient/payee provides services within the City
V The public purpose is beneficial to the en c ry b such donation
Dated: By: '
Requesting Member of the City Commission
S:\CC\WP\COMMUNITY INVESTMENT FUN DS\Community_Support_Funs_Policy.201S.doc