HomeMy Public PortalAboutTybee Beautification ,440 ' 1.4,,,<-"c,
' ' ) CCu� of ,I)Dee Island Coiannaaannvnty Set- `.yes Connn-act Award
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\ \ j Fiscal Year 2013-14
ZiPPLICATION FOR CASH AWARD
This form is to be co pleted and submitted to Finance with your budget request.
Date: April 29, 2013
Organization requesting City of Tybee Island Community Services Contract Award:
Name of Organization: Tybee Beautification Association
Contact Person: Deb Barreiro
Address: P.O. Box 604, Tybee Island, GA 31328
Contact Email: tvbeedocoark @hotmail.com
Contact Phone #: 912.398.0552
Is this organization an IRS approved 5 01(C) 3 Non-Profit? Yes
If"yes", please attach your most vecent audited financial statement, a copy of your IRS
determination letter and a copy of your current budget detailing the planned use for the
awarded funds. j
Amount of funds requested: $ f�-'
Describe how these funds will be used and how the City and citizens of Tybee Island will benefit: a
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 B ter Avenue,Tybee Island,Geer& 31328-2749
(912) 786-4"—3—FAX (9112) 786-9465
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aty of Tybee island Community Services Contract Awe---'
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3cali Year 2013-14
APPLICATION FOR WAIVERS
Date: April 29, 2013 1g A i -011.3
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):
We are requesting the use of the Guardhouse on the 2nd Wednesday of each month and for special occasions if
available. We request that any fees associated with the use of the Guardhouse be waived.
We are requesting parking passes for the participants of our Beach Sweep events. During the year 2102, it is
estimated that TBA received 250 hours of parking for participants.
Value of the wahters requested: $ 7700 ($7200 for guardhouse & $500 for parking)
F.O.Mott 2749—403 &diler Avenue,Tybee Esintrpd,Georgia 31328-2749
(9E2) 786-4573—FAX(912) 786-9465
wv wr%o.ityoftybee.org
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AffidEdit Verifying St.tus
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Tor City Public Beneff Applicatamm
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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 Deborah Ann Barreiro(printed name of natural person applying on behalf of individual, business, corporation,
partnership, or other private entity).
1) YES 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 Code Section 16-10-20 of the Official Code of
Georgia.
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Signature of Applicant
I\iiift40...5 ' '
Date
Yy ,,f-`rtw'
Printed Name
SUBSCRIBED AND SWORN BEFORE ME ON Tl lIS
THE DAY OF ,20
Notary Public v �_
My Commission Expires:
Note: O.C.G.A. §.50-36-I(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 ident5ing number below:
inter(IL.1 Revenue Servioe Department of the Treasury
Distr11,7t: DirQctor 401 W: Peachtree Street
Roam 1149. stop 520-D
Atlanta, Georgia 30370
Data:
OCT 1 1 1995
Person to Gontaot :
Cynthia Smith
Tybee Beautification Aesn Inc Contact Number:
Post C'ffice Bux 1005 (404) 331-4938
Tybee Island , GA ..312B-1005 Refer Rep"Ly to:
E0:TPA: 74D4
EIV: 53-172812
FRI: 560081600
r.tear Taxpayr:
This is in response to your inouiry concerning the tax exempt
statu,7 of your organizetjon.
Our records indicate your organization was granted exemption from
Federal income tax under section 501(o) (3) of the Internal
Revenue Code by our letter dated September, 1993.
Our ruling letter further granted you an adtrance ruling that you
oan reasonably be expected to be a publicly supported
organization described in section 509(a)( 21 of the Code,
The advance ruling period ends August, 1997 ; at which time we
will contact you far further information so that we may determine
whether you have met the requirements of the applicable support
test during the advance ruling period.
Contributions to you are deductible as provided in section 170 of
the Code .
The 501(o ) (3) tax exempt status recognized by our letter referred
to above La currently in affect and will remain in effect until
terminated. modified or revoked by the Intern 1 Revenue Service .
Any changes in your purposes, character, or method of operation
must be reported to us so we may consider the effect of he change
on your exempt status. You must also report any change in your
name and address.
Thank you, for your cooperation.
A7 no ere ly
Ex iknpt. Organizations Coordinator