Free 50424.pdf - Indiana

APPLICATION FOR LIVESTOCK INDUSTRY PROMOTION (Section 1)
State Form 50424 (R / 9-03)

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

This Section 1 application is for conducting livestock shows, sales, exhibitions, conventions, or similar events/projects.

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:

Event or Project start date: Nam e of Eve nt/Projec t: Location of Even t/Project: Estim ated Nu mbe r of Participa nts: Exhibitors: Total Ev ent/Proje ct Cos t:

(Events/projects start date, please refer to application guidelines)

Cou nty: Attendees: Fundin g Req uest:

LIVESTOCK SPECIES: - Check all that apply to the event/project for which funding is requested.
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)

FUNDING HISTORY WITH LIVESTOCK PROMOTION FUND:
Number of years this event/project held: Are you a first time applicant?

YES

NO

Number of years this event/project funded:
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SECTION 1 - APPLICATION FOR LIVESTOCK INDUSTRY PROMOTION

SCOPE: - What is the impact area of this event/project? County State Multi-State Regional National International Other: (Explain)

***USE ONLY THE SPACE PROVIDED TO ANSWER THE FOLLOWING QUESTIONS: SUMMARY - Describe the event/project.

GOALS: - List the goals of the event/project.

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SECTION 1 - APPLICATION FOR LIVESTOCK INDUSTRY PROMOTION

USE OF FUNDS: - Describe how funds will be used.

BENEFITS: - Explain how this event/project will benefit the livestock industry in Indiana.

PROCESS: - Indicate what methods and criteria will be used to track the success of the proposed event/project.

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SECTION 1 - APPLICATION FOR LIVESTOCK INDUSTRY PROMOTION

DETAILED BUDGET: - See attached event/project budget sheet (Exhibit B). This sheet must include all anticipated expenses for the event and must be included with grant request. If this event/project was held previously, please attach the most recent final expense report. ** Include a copy of your not-for profit IRS determination letter ** The Livestock Promotion and Development Fund will give preference to events/projects that provide at least a 50% funding match. Remember, this is a reimbursement grant for which you are applying.

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 APPLICANT HAVE LIENS OR POTENTIAL LIENS WHICH COULD JEOPARDIZE THE COMPLETION OF THIS EVENT/PROJECT.

SIGNATURE* *Highest Ranking Officer, President or Executive Director

TITLE

DATE

Submit Application and Supporting Documentation to: ( E-MAIL 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 n ot-fo r-pro fit deter min ation letter ( cop y) Financial report from last year's event. Signature Sheet W -9 Form

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