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� ��-�� � - � � �J' <br />��� ���R �.� YE <br />�`�'2005 SpecialInitiative <br />� y 7t� � ; i � �� <br />�L�1'����.� : � � -�--� . <br />� . . <br />� � �� 1 8 �0�4 . <br />I � 3,�j�`�:?; r;�i.� <br />� � t� ���,,,r r�:q��;�=1 <br />❑ 2"d Year Request Project StartDate � � � ' ' - ' � <br />n::.ji?.i;��*_ <br />�:�`'' Year Request Project End Date �� <br />mo. l �;' yr, <br />:� }� �rl��an� C� s���� � � +��� ��,r � � �,- � ��v c'�� �.. �- - <br />,�c�= r•�.� ���o� �-ti �� ���.-ti� fr � v a 1! � <br />c:_��, �i�i�. �� �}� � ��r'�l� � . _ i� � �� � � � <br />a�li;�-.c���— �� � � � y,�� ���,x�� �� �r � �� -- � 1� <br />i.i :n �. iJ �1ti �-'� ���� � � . �++� �����. ��'�:� :'�cit�rc}s � � . YbS���� �ti �. .f''�*'� �rt. <br />� v�+-ti. ��s <br />�.'c�tr�al.: �,��'+� � �+.-� VIN J �o�se T)i.�Eri.i � � . — — <br />(Districtnumbers are required �ii!� 1; �riu� Information,; I 651-296-2146or visit -, �t ,;��_��It�r!�'�:rr'����_�: f.�.a; ir;'�,rr.r r'ri� i <br />Project Contact_���� �*'���� <br />(The contactperson should be available to answer questions about this application.) <br />Phone (w)-(R�1- -19'2-7�02 -- (�} �[��:i �n.. 1-��] �bC� <br />E-mail � `�� ;����� � E"�..1�'.����ij���. ��+ • ll S . . —•-• -- —•- <br />If your group is not usi�x� a j4scal agent, t)tis section will be blank. <br />Fiscal Agent <br />1 rl tl r:��:� <br />City, State, Zip —.__ _ <br />Contact Person <br />Phone (w)_ <br />� , _ � mail _ - <br />r� F}p r���:�1 �f �*] i�� nt �,ir���p r� 1X L' LLL�J k'i� Director or Board Officer is required. <br />�iirii;:-llfC �— , _ �ltl�—��. �. �'1������ ..— <br />I", : � � I i �<7�_�,� � ��] . _ Date ����� 7 __ - � — — - <br />r---�-- --- -• — •— I <br />Complete this fornt or generrz#e your r.;ti,�; form <br />zuiflz thest�rne irz�fol•1r�r�tinli in the.:�;�,;,� fararzat. <br />�--•- -- • • --- ., _ I <br />