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HomeMy Public PortalAbout020_023_Tybee Island Community Pool �.�` rte' . � City of Tybee Island Community Services Contract Award "'i' Fiscal Year 2015-16 r +sr4 ;sc. APPLICATION FOR CASH AWARD This form and all attachments are to be completed and submitted by March 20, 2015 Date: 4/-ch 47 .mil l Organization requesting City of Tybee Island Community Services Contract Award: Name of Organization: 1 ! bee _Wit f Y4. e pry ,91 Ail 7 1 C 1 1 , Contact Person: 'ti t r ki. L-go;f1en Address: e , _ 5 1 __ Contact Email: VI+.ybee.a. rrta ; 1 Contact Phone #: CPA 7.6 -?' -- Is this organization an IRS approved 501(C) 3 Non-Profit? X Yes _ No If"yes", please attach your most recent audited financial statement, and a copy of your IRS determination letter. Amount of funds requested: $ -- Lit t Describe how these funds will be used and how the City and citizens of Tybee Island will benefit: Li [ei-cte All tot , —rib ee, free,dt ,`t uui) )1 p` i Affet I)ejtne-CJ nil cLL( f Lee (3.1 py4: icce'1 [ 1 eeDL G/i ia ) a J- ' r 4r. ' 41 • A itei 4 ;r r - ■ _- . - V.-- C 111 f\)t v e'Ji he r .2h)5 i . _) i, IT _ -z. t�' 'e4e . 4,, r t' .t:c .. nee A r► --) ,-- W r f f 4m V.'..i- '1`'] k . 1 cti►ren s 1,i,11 L'n l It'"/ i ) tLse et gr,,v Pal; What percentage of these funds will m.t edb your organization? 6L? pe 9 Y Y 9 Will this event or program bring visitors to Tybee Island in off-peak season or months? Yes, �>Please attach a detailed budget to this request outlining how the money will be used. P.Q. Box 2749—403 Butler Avenue.. Tybee island., Georgia 31328-2749 Treasurer's Report Tybee Island Community Pool, Inc. t�. 1 December 18,2014 South State Bank - Beginning Balance 8/29114 $17,931.66 09/22/14 Deposit $ 728.00 10/03/14 Deposit 1,036.00 10/14/14 Deposit 727.00 10/20/14 Square Deposit 336.47 10/21/14 Deposit 705.00 10/21/14 Deposit 2,988.00 10/30/14 Deposit _ 311.00 $ 6,831.47 $24.763.13 CK##1039 09/04/14 Jackson Printing $ 293.49 CK#1 03 8 10/21/14 Sun Country Amusements 25.00 CK#1040 09/16/14 Speedi Sign 48.15 CK#1041 09/24/14 Cappy Birdwell (supplies,noodles) 85.29 CK#1042 09/26/14 Savannah Awards 8.55 CK#1043 10/14/19 Badger Rental (fan for testing) 48.15 CK#1044 1 0/20/14 Bahama Joe's 282.48 CK#1045 10/14/14 Cash(Derby Awards) 2100.00 CK#1046 10/21/14 Sun Country Amusements 175.00 CK#1047 10/23114 Caprice Birdwell (food.tickets,cash box,table covers) 139.00 CK#1048 10/23/14 Caprice Birdwell (Badger Rental-fans) 192.00 CK#1049 11/04/14 Jeff Wells(Thank you for services) 100.00 CK#1050 11/04/14 Sandy Major(printing of flyers) 257.97 $ 3755.08 $21,008.05 South State Bank-Ending Balance 11/28/14 S21,008.05 DEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE P_ O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: 90-0791148 Date: DLN: 17053172364022 COMMUNITY POOL INC Contact PerS011: _v C/O ISLE KEITH JOYNES PO VICTORIA K 85 ,� WOR Contact Telephone Number: PO BOA 859 TYBEE ISLAND, GA 31328-0859 (877) 823-55 Accounting Period Ending: F ebruarY 28 Public Charity Status: 170(b) (1) (A) (vi) Form 990 Required: Yes y �/ { Exemption: j L Effecti '- Date of V February 7, 2012 2 ( Cantr utiou Deductibility: Yes lrt T 5J Addendum App es No Dear Applicant: upon review of your application for tax We are pleased to inform you that up t from Federal for to tax that you are exemp Contributions is tm you are mined tha Y exempt section 50 have determined xfiti to receive under section 501{e) {3) of the internal Revenue Code. also qual Code_ You are deductible under section. 170 of ��ransfers©r S. ft��d'� section 2055, 2106 bequests, devises, resolve any questions tax deductible bode this letter could help a 2r 5�2 of the Code. Because permanent records. you should keep it in y�' regarding your exempt status, Y your t under section 5o1(c) (3) of the code are further classified private foundations. We determined that you are Organizations exempt of this as either public Charities or p a public �h�rity under the Code section(s) listed in the heading letter. Please see enclosed Publication 4221-PC, Compliance Guide for 501(C) (3) Public Charities, for some helpful information about your responSisilities as an exempt organization, Sincerely, **dill t ‘144°. ..'°.'. Kenneth Corbin Acting Director, Exempt Organizations Enclosure: Publication 4221-PC Letter 947 (DO/CO) TYBEE ISLAND COMMUNITY POOL Itemized list Post Cards for mailings: $300.00 Membership brochures: $300,00 Advertising of meetings: $150_00 On-line information: $100.00 Refreshments: $150.00 Total: $1000.00 sg 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 i t F ` j:540,1' S- 6' ( L ki t'i i le!,/„I Ili C ' , 1-/printed name of natural person applying on behalf of individual, hus2ne x, corporation,partnership, or other}rivate entity). 1) L' 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 violatiio�n/ooff,Code Section 16-10-20 of the Official Code of Georgia. Signature of Applicant c 0-C Date Dar) Printed Name *Alien Registration Number for Non-citizens SUBSCRIBED AND WORN BEFORE ME ON THIS THE 9 DAY O ,20 Notary Public 4' My Commission Aires: /o —e y — Note: 0.0 GA. ,¢5O-36-1(e)(2) 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: JANET ft, LEVINER Notary Public,Chatham County GA \v Commission Earo!re4s Oct A€#,200