HomeMy Public PortalAbout020_011_Beach Bum Parade bfk
City of Tybee Island Community Services Contract Award
Fiscal Year 2015-16
APPLICATION FOR CASH AWARD
This form and all attachments are to be completed and submitted by March 20, 2015
Date: 2/15/15
Organization requesting City of Tybee Island Community Services Contract Award:
Name of Organization:Beach Bum Parade Committee
Contact Person: Jack Boylston
Address: PO Box 895 31328
Contact Email: tybeejack @live.com Contact Phone #:912-658-8134
Is this organization an IRS approved 501(C) 3 Non-Profit? X_Yes(tax exempt) No
If"yes", please attach your most recent audited financial statement, and a copy of your IRS
determination letter.
Amount of funds requested: $
Describe how these funds will be used and how the City and citizens of Tybee Island will benefit:
What percentage of these funds will be matched by your organization?
Will this event or program bring visitors to Tybee Island in off-peak season or months?
>>Please attach a detailed budget to this request outlining how the money will be used.
P.G. Box 2749 e 403 Butler Avenue,Tybee Island,Georgia 3I328-2743
(912) 786-4573—FAX(912)786-9465
www.cityoftybee.org
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APPLICATION FOR WAIVERS
Name of Organization: Beach Bum Parade Committee_
Provide detail on any waivers (i.e. free or reduced parking, rent or utilities) or City services
(i.e. number of hours of security, city worker clean-up, trash and/or recycle bins, building maintenance and
upkeep, etc.) that you plan to request for your event(s):
All of the above to include everything provided in the past and anything other deemed necessary to run a
smooth and safe parade.
Value of the waivers requested: $ per city's value
P.O. Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749
(912)786-4573—FAX(912) 786-9465
www.cityoftybee.org
Affidavit Verifying Status
for City Public Benefit Application
By executing this affidavit under oath,as an applicant for a City of Tybee Island.Georgia, Business License or Occupation Tax Certificate,
Alcohol License,Taxi Permit,Contract,or other public benefit as referenced in O.C.G.A. Section 50-36-1, I am stating the following with
respect to my application of a City of Tybee Island:
• Business License or Occupational Tax Certificate.
• Alcohol License,
(circle all that apply)
• Taxi Permit,
• Contract
• Community Services Contract Award
for lybee Island Beach Bum Parade Committee(printed name of natural person applying on behalf of individual, business,
corporation,partnership, or other private entity).
1)X I am a United States citizen.
OR
2) I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal
Immigration and Nationality Act, 18 years of age or older and lawfully present in the United States. *
In making the above representation under oath, I understand that any person who knowingly and willfully makes a false,fictitious,or fraudulent
statement or representation in an affidavit shall be guilty of a violation ofCode Section 16-10-20 of the Official Code of Georgia.
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Signature of Applicant
� � j
Date
Jack Boylston
—
Printed Name
*Alien Registration Number for Non-citizens
SUBSCRIBED AND SWORN BEFORE ME ON THIS
THE 4 4 DAY OF ,20
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Note: O.C.CLA_§5O-36-1(e)(?)requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended,provide their
alien registration number. Because legal permanent residents are included in the federal definition of"alien", legal permanent residents must
also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying
number below: