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Applicant artization: l`,, , } ~ ' ~ ~ o'-f- 1~vS~ ~~ ~1 ~ ~ t.avv.et.~. 1~,a~o ~C ~}~e `t~ i iS t u ~•. Address: ~ ~ S e it ~ ~ i ~, I ~'\ ~~' , S- 113 Aunt requested: `~ S~, 6 ~ ~~ Proposed Starting Date: J C~;v~ \~~ ~ ~, ~ D t3.3 Telephone: (~S t) ~ `1 ~ ` <~ :,l c) E-mail Address: C ~..Af~~y,-.. C~~-~,~~ C.~ . f~~~ ~,~i~ rn~+ "tdt Fax: (~ S J) ~~~ ~ - ~ ~ ~7 ~ Chief Executive Officer. ~ ~ ~~ ...~ . ~.~ ~ ~,S Project Contact: ~r~1 ~, ~. ~ v.r~ Project Tide: ~~'~~~~tit~ Ck~ ~ ~~~~~ ~- I~aC. ~ ~~" ~~ ~~r~~~~ ~~ ~~e l-, Ending Date: ~~ C' ~ ~ ~~`~~ ~ .,..~ U Ci " All applications must include the documentation listed below and the information requested in the narrative guidelines on the back of this fonzt. ~ "~ 1. A copy of the applicant organization's most recent letter of exemption from the Intemal Revenue Service demonstrating that it is an organization exempt from federal income tax under section 501(c)(3) of the Intemal Revenue Code, and stating whether or not it is a private foundation. '' f 2. Audit or year-end financial statement for the most recently completed fiscal year; the current year's operating budget; and current year-to-date income and expense statement. ~ 3. Names and affiliations (place of employment and/or other relevant community involvement) of the policy board responsible for the management of the applicant organization. 4. Indication that this application has been reviewed by the governing Board of the applicant organization and has received its endorsement. Where possible, a formal Board resolution to this effect should be submitted. In submitting this application, the applicant agrees to the following: 1 • The applicant will spend funds solely for the purposes stated in the application and will refund the unexpended portion of such funds, if any. In addition, the applicant will provide interim and final reports as are required by the Foundation. 2• The applicant realizes that payment of funds granted will be at the convenience of the Foundation, including cancellation of the grant and/or modification of previously agreed upon payment schedules should such cancellation or modification be deemed necessary by the Foundation. 3• The applicant understands that the Foundation, in researching this grant application, may review any and all of the information submitted as part of this request with advisors of the Foundation's choosing, if deemed necessary by the Foundation. 4• The applicant has made a determination regarding the applicability of the Minnesota Charitable Solicitation Act (MS309) and intends to comply with the terms of this Act, if appropriate. ~ ~ Signature: Chief E e five Officer Date • THE ~'alnt I-'aul FOUNDATION