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HomeMy Public PortalAboutFriends of Tybee Theater Cnty outs¶'ybee as:z nd CommunI y Se rvaces Contir ct Awnrcl see Yeti° 2E3-24 4 PPI.ECQ EC H I© ©ASH kTEMED This form is to be completed and submitted to Finance with your budget request. Date: a 24 Z / Organization requesting City of Tybee Island Community Services Contract award: Name of Organization: 1'/�'/�'a✓l � 01? ,/ye- //1G�- /AEA?. 4=/? Contact Person: VW-1 nZ k 6/ Address: imp 4pX ag. Z 7/1- Contact Email: 7)4(ev/ &)''g7/ 4 SSEontact Phone #: 9-A 9---/9 79 T Non-Profit?Is this organization an approved �®1(C) 3 Von profit. Yes No If'yes„ please attach your most recent audited financial sttaternent, a copy of your E RZ c!etemTLTat orn Doter and a copy of your current budget detailing the planned use for the awarded funds. Amount of funds requested: $ //,,,,.<<..i, Describe how these f rids will be used a hgw w the City and citizens of Tybee island will benefit: (/ What percentage of these funds will be matched by your organization? #/ aiiri. mill this event or program bring visitors to Tybee Island in off-peak season or months? /eJ >C'Usa.se aL2ach a detailed budget to tL e request ou enhw how the money ill be used. j 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 • Communi)zt Services Co tract Award for Jib? /t1 L7g (printed name of natural person applying on behalf of individual, business, corporation,partnership, or other private entity). 1) *"...—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 of Co Section 16-10-20 of the Official Code of Georgia.''../.14‘''''''' Signature,' Appl' ant 7 Date z Printed Name *Alien Registration Number for Non-citizens SUBSCRIBED AND WORN BEFORE ME ON THIS THEsV 7 DAY OF V a `._,/ , 20/3 JANET R. LEVINER Notary Public,Chatham County Notary Public t v r,°;nr.1.w;, ,^w: =v1traq Oct. ?6,2016 My Commission Expires: /d /6 I to ' Note: O.C.G.A. §50-36-1(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. Quaked aliens that do not have an alien registration number may supply another identifying number below: I 3:00 PM Friends of the Tybe Theater 01o7/13 Profit & Loss Budget ItIfollfieW Accrual Basis January through December 2013 TOTAL --JinT3 - -Feb 13 Mar 13- -�p�3_ --M��3__ __J"��- __om13 _���-' __�p��-- Oct 13 u��r- ���-' �i�l�cTn o*wory*""m*Expn"= mcom°m°�u°,�*,n"~m° amm� 0.00 0.00 0.00 0,00 0.00 0.00 n�� 0.00 0.00 0.00 0.00 8,000.00 401 ' 400•o=m" ""° 25,000.00 � oo 25,000.00 25,000.00 420 Fundralalny Event Net income ��mm.no 80,000,080,000,00 u -- -____ _� _ __ ___ _�_____ __ _____ ___._ _ ______ ___ _ - � � Total m"°" 113,000.00 0,00 vm 0.00 0.00 mm mm 0.00 0.00 0,00 0.00 0.00 113,000.00 Expense 3,500.00 wn•���ws�*� 3,500.00 250.00 mm•oo*m"� 250.00 ��oo mo•����u�n� 500.00 ��� �o.�m*a 32,000.00 0.00 v2m,ve��*�*s"p^=e 0.00 350.00 wr/.ou=,nm"mu,"m/:pmy 350.00 �muo mm•s,,*"em 500.00 omm.ov ouo•/w*m�Expense 9,000.00 9,000.00 ' ^mm� ex./,w"mn",s,�me *'mm.on . 637•ucense&p°"nxs 200.00 200.00 om•mwm°*oo=°umopa/m 1,000.00 1,000.00. 1,500.00 wm•o�" Supplies 1,500.00 . wm.~��� 300.00 300.00 645'Travel and EntertaInment 250.00 4,000.00 6�.umm�sx ^� 4,000.00 ovv•Payroll Tax Expense 0.00 0.00 •p"x �wum Services ~ 1munn � `1,500.00 o � _. __ Ta�*�~ ���� 59,350.00 - � _ _ ^ (1 Net Onileary,Income 53e0.00 ~ _'-m� uov 000 uoo 0.00 0.00 0.00 uuu 0.00 uoo 0.00 53,650.00 Other Income/Expense ~~er~ 10,000.00 ow•memmomv"p"�v /ovu/n�o 10,000.00 Professional ' 12,510.00 mm'moxnme�u Reduction ^Zeuoo __ ����' ---- ��mm Total 22,510.00 _____ _______ xe.nm�ou Net Other Income _���,�� _______ ____�__ ________ ______ __ _ _ . _______ �_______ ________ Net Income 31,140.00 os um o/m ..___mm 0.00 mm 0.00 0.00 0.00 0.00 0.00 31,140.00_` _._ ___` Page 1 � �