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Home My Public Portal About020_025_Tybee MLK Parade ttr ,: • City of Tybee Island Community Sery ices Conti-let et Award Fiscal Year 2015-16 APPLICATION FOR CASH AWARD This form and all attachments are to be completed and ibmitted by Mares 2% . . 15 Date: '7/ Organization requesting City of Tybee Island Community Services Contract Award: Name of Organization: C L 'AAA l G, ,: d e , , Contact Person: ` '.z/ 4 'P.6741ee--5 Address: -144 r/ 7 / . 71F-Se' Pe9.7,4P 3/ °° Contact Email: %I '`e,' .4,1 J1_ Contact Phone #:(-9/2j c/-r-", slug / Is this organization an IRS approved 501(C) 3 Non-Profit? Yes X 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: AilitiN9 et 7 C,/t 0' C 1) -- q-Men),94) J4Z 2 ) c , `e69, . e-s7- 4 A)4lY T/ o IQs- C'74 r ' A--ed ?we/9 _ 9., eciEeekiiil ri0A).:- 0•47-v Z>,$ J-Ailtomy 9, 2O/ {J:/,/ s. 779 iA/CLe-406 -2)Pkvi p674ee:, r i?ai? m/6 GIs, ' ~s . . 7,92.5 e1/&i7 7549s - .• 0' D6 No '. . c 7e-P-P) -To—7"V.66- -'r,4!? 4i ,t-" ',C7 77O.�' ,,V 77oA 42 767/624a,/ J8V ,0 /2 l e g- C^ (/,4L, 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.O. Box 2749-403 Bailer Avenue,Tybee Island,Georgia 31328-2749 (912)786-4573--FAX(912) 786-9465 www.eityoflybee.ofg ja City of Tybee Island Community Services Contract Award Fiscal Year 291546 APPLICATION FOR WAIVERS Name of Organization: 7 E/II 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): D '., 4,€T1 ' 4 eiTNE, i 6 ,.r, b-oe�2- moo, IDS -c' 133yR i 62i 3na 62-,,,,,,,,,,Lt, 73-":84Z-Aix-K 2.46,906---.r -, t;4, laii it� o mr ,. .„49/7.7 OJ o g 1[.z.� �. - Pte', O2 ICS` Secicv 20 ,Po9 F � 6- e/750 ) . /9 j dd 16- tg . ®c , /e .� Se4 , (/ ; / ` -6eep - ss etv-ea7 T 4 ei ,€ .d'' .- A ,7 ,t a,,,,,, , ,/g, & / 1 a . % zeot.1ei . 9, 7 7 7y - r v .-6.e Li5-0A), D7o .-C7 n gee, /0 u J f / a/9,25 4,06,92 s7,97-t/Fe,,b4y ,L, :--,ilivimer 9, .21 .4 2 Value of the waivers requested: $ 11/ 5-00 P.O. Box 2749--403 Butler Avenue,Tybec L}tKnd,Georgia 3132&2749 (912)786--1573—FAX(912) 706-946+ w•.eitywfftybee.org Wells Fargo StoreVision Platform Page 1 of 1 Search t Sales I}Banker Toolbox I Administration I Main J Sign Off Quick Profile I Customer List (0) I 0 Clear List A�r co l cci-akaeo lai sva_2s9,o:1_a Gold Business Services Package 6124427672 Bank GEORGIA(297)Detail I Address I }listory I Statements I Stop Payments I t1oldsFPiedges I Overdraft/NSF Fees I Service Fees Check Orders I Transfers I Cur omer sent History I Documents Checking/Savings Account History I select actin. ,1 Tax Responsible Customer TYBEE MLK Sole Owner Additional Customers DANIEL C HILL Signer JULIA PEARCE Signer Ledger Balance $1,874.00 Available Balance $1,874.00 Check Date Description Number Amount Balance 03/02/15 Recurring Transfer To Tybee MR Business Market Rate Savings Ref 150.00 1874.00 #opetwkjjwf Xxxxxx8602 02/27/15 Monthly Service Fee Reversal +14.00 2024.00 02/27/15 Monthly Service Fee 14.00 2010.00 02/17/15 Recurring Payment Authorized On 02/13 Vistapr`website.pk 866- 5.00 2024.00 6148002 Ca$385045093293196 Card 8062 02/02/15 Online Transfer From Tybee MIk Business Market Rate Savings +150.00 2029.00 Xxxxxx8602 Ref#ibegb4jgld On 02/02/15 01/30/15 Monthly Service Fee Reversal +14.00 1879.00 01/30/15 Monthly Service Fee 14.00 1865.00 01/29/15 Recurring Transfer To Tybee MIk Business Market Rate Savings Ref 150.00 1879.00 #opetw8wh74 Xxxxxx8602 01/29/15 Deposit Made In A Branch/store View Deposit 896101642 +100.00 2029.00 01/22/15 Purchase Return Authorized On 01/17 Vistapr*website Pk 866 811 +179.99 1929.00 1674 Ca 8625022545828474 Card 8062 01/21/15 Deposit Made In A Branch/store View Deposit 896051633 +200.00 1749.01 01/20/15 Deposit Made In A Branch/store View Deposit 870939455 +120.00 1549.01 01115115 Purchase Authorized On 01/13 Vistapr*website Pk 866-6`148002 Ca 179.99 1429.01 5385013199896501 Card 8062 01/14/15 Deposit View Deposit +40.00 1609.00 01/12/15 Deposit Made In A Branch/store View Deposit 896051632 +270.00 1569.00 01/09/15 Deposit View Deposit +450.00 1299.00 01/09/15 Deposit Made In A Branch/store View Deposit 896134453 +360.00 849.00 01/07/15 Check View 1001 100.00 489.00 01/02/15 Online Transfer From Tybee MIk Business Market Rate Savings +150.00 589.00 Xxxxxx8602 Ref#ibetw27nyb On 01/02/15 01/02/15 Deposit Made In A Branch/store View Deposit 896001805 +200.00 439.00 01/02/15 Deposit Made In A Branch/store View Deposit 896001804 +150.00 239.00 12/31/14 Monthly Service Fee Reversal +14.00 89.00 12/31/14 Monthly Service Fee 14.00 75.00 12/29/14 Recurring Transfer To Tybee MIk Business Market Rate Savings Ref 150.00 89.00 #ope8hnt2c9 Xxxxxx8602 12/17/14 Deposit Made In A Branch/store View Deposit 896184240 +40.00 239.00 12/10/14 Check View 1025 1299.61 199.00 12/09/14 Deposit Made In A Branch/store View Deposit 896184242 +100.00 1498.61 12/08/14 Online Transfer From Tybee MIk Ref#ibe8hhgpp5 Business Market +150.00 1398.61 Rate Savingmonthly Transfer Back To Regular Accounnt 12/08/14 Deposit View Deposit +660.00 1248.61 Search I Sales I Banker Toolbox I Administration I Main I Sign Off arnha pplalpru4_svp 255.17.3_e mh.eccauniHist ry https:l/al-site!.sales,and.se vice.wells farg o.comisvp/accountHistoryinit.do 3/3/2015 t 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 ,/A e., iF ar re e rrrF porsore opplying on belpoiforf 1dum business,corporation,partnership,or other private errtity4 1) \ I am a United States citizen. OR 2) _ [ am a legal permanent.resident 18 years of age or older or I am an oth-ent'isc qualified alien or non-fit under the Federal Immigration and Nationality Mt,18 e.. . of age or older and 1. rfull present in the United So aes...* In making the above representation under oath,I understan that any -•+ who g.u y and winfuttY makes a false,fic6tiL I . crr fraliduleat statement or representation in an affidavit shall he guilty of viofati , of C _, [O-2O of the Official Code of fitectrgia.. .4 AL arra-.1:41 ru of Applicant OPP" G 3 ram ti l--!A _o ck_ - .1 Ptwted Name *Alien Registration Number for Nou-citize SUBSCRIBED ANDS ORN BEFORE ME ON THIS THE ci DAY OF 20 JANET R. LEVINER Mary lam.Chatham CaNaV OA Notary Public O'��lcr'Ems rid_*v My Commissiwtxpires: / 'V —/4' Note: O C G-A- §50-36-1(e)(2) requires that aliens under the federal Iaaarnigrartioa an^d Nationality Act, T"it"le tl L'_.5CC_as amended,provide their alien registration number_Because legal permanent residents are included in thefederal deffnitsan of`alien", legal permanent residents must alto provide their alien registration number. Qualified alien, that do not lur►ve an alien registration number num supply another identifying number below: