Free 50425.pdf - Indiana

APPLICATION FOR EXPANDING MARKETS FOR INDIANA LIVESTOCK PRODUCERS (Section 2)
State Form 50425 (R /9-03) This Section 2 application is for value added feasibility studies, research projects, market development, or other projects that encourage the development of business and industry related to livestock production, processing, and distribution.

STATE OF INDIANA
Livestock Promotion and Development Fund Office of the Commissioner of Agriculture Joseph E. Kernan, Governor Joseph R. Pearson, Assistant Commissioner of Agriculture

Organization Name (no n-profit): Organ ization's H ighest-ran king Offic er: Officer's Address: City: Phone Num ber: Email Address: Grant C oordina tor: Grant Coordinator's Address: City: Phone Num ber: Email Address: State: Zip Code: FAX Nu mber: State: Zip Code: FAX Nu mber:

Federal ID#: Title:

Cou nty:

Title:

Cou nty:

Project start date: Project end date: Nam e of Pro ject: Total Pr oject Co st:

(Projects considered for funding must not begin until grant award is fully executed.)

Fundin g Req uest:

LIVESTOCK SPECIES: - Check all that the project will affect.
Aquaculture Horse Swine Beef Llama Bison Ostrich Dairy Poultry Elk Rab bit Goat Sheep

Other (refer to I.C. 4-4-3.2-1)
(Explain)

SCOPE: - What is the im pact area of this project? Coun ty State Multi-State Regional National International Other:
(Explain)

Page 1 of 4

SECTION 2 - EXPANDING MARKETS FOR INDIANA LIVESTOCK PRODUCERS

***USE ONLY THE SPACE PROVIDED TO ANSWER THE FOLLO WING QUESTIONS:

SUMMARY: - Describe the project.

ECONOMIC VALUE: - How will the project encourage the development of indiana livestock production, processing, and distribution?

GOALS: - What are the g oals of the project?

Page 2 of 4

SECTION 2 - EXPANDING MARKETS FOR INDIANA LIVESTOCK PRODUCERS

USE OF FUNDS: - How will the livestock promotion funds be used?

OBJECTIVES: - Provide clear and logically arranged objectives.

RESOURCES : - List oth er reso urces outsid e of you r organ ization , such a s con sultan ts, to be used for this project. Describe how this individual or group will be selected.

Page 3 of 4

SECTION 2 - EXPANDING MARKETS FOR INDIANA LIVESTOCK PRODUCERS

DETAILED BUDGET: - See attached project budget sheet (Exhibit B). This sheet must include all anticipated expenses fo r the event and must be inc luded with g rant request.

*** Include a copy of your not-for-profit IRS determination letter.***
The Livestock Promotion and Development Fund will give preference to projects that provide at least a 50% funding match. The Livestock Promotion and Development Funds will be distributed as follows: 75% upon completion of the contract. The rem aining 25% w ill be allotted upon sub mission of ad equate final report. In the ev ent grant reports and supporting documents are not received by OCA, the grant contract will be considered in default; and any remaining grant distributions will be forfeited and applicant will be required to repay all amounts that have previously been received for this grant. UPON SIGNING THIS REQUEST, I AM CERTIFYING THAT APPLICANT IS NOT IN VIOLATION OF ANY STATE OR FEDERAL LAW, OR MUNICIPAL ORDINANCES AS OF THIS DATE. NO MONEY IS DUE AND PAYABLE TO ANY MUNICIPAL, COUNTY, STATE OR U.S. GOVERNMENTAL AGENCY OR DEPARTMENT, NOR DOES THE APPLIC ANT H AVE LIE NS O R PO TEN TIAL L IENS W HICH COU LD JE OPAR DIZE T HE C OM PLET ION O F TH IS PROJECT.

SIGNATURE* *Highest Ranking Officer, President or Executive Director

TITLE

DATE

Submit Application and Supporting Documentation to: (EMAIL AND FAX APPLICATIONS ACCEPTED, YOU MUST PROVIDE A SIGNED ORIGINAL APPLICATION WITHIN 5 BUSINESS DAYS OF DEADLINE.)

Director Livestock Promotion and Development Fund Office of the Commissioner of Agriculture ISTA Center - Suite 414 150 West Market Street Indianapolis, Indiana 46204-2810

Checklist. Did you include? Application Budget Form IRS no t-for-prof it deter min ation letter ( cop y) Signature Sheet W -9 Form

Page 4 of 4