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APPI [CATION FOR <br />K(V ;0 Faso M <br />OMB Approval No. 0348-0043 <br />FEDERAL ASSISTANCE <br />2. DATE SUBMITTED <br />Applicant Identifier <br />3/31/05 <br />1. PE OF SUBMISSION' 3. DATE RECEIVED BY STATE State Application Identifier <br />ADplieafion Preapplicatlon - <br />Construction Q Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br />Non-Construction ❑Non-Construction <br />5 APPLICANT INFORMATION <br />Legal Name: <br />Organizational Unit <br />Lee Count <br />Address (give city. county. Slate. and zip cede): <br />Name and telephone number of person to be contacted on matters involvin <br />225 S. Steele St. <br />this application (give area code) <br />Sanford, NC 27330 <br />John W. Payne <br />Lee Count <br />1 <br />y 6 EMPLOYER IDENTIFICATION NUMBER(EIN): . <br />7 TYPE OF APPLICANT: (enter appropriate letterin box) <br />5 6_ [660 D 0 3 1 3 <br />A. State H. Independent School Dist. <br />i <br />8. TYPE OF APPLICATION: <br />ng <br />B. County L State Controlled Instilubon of Higher Learn <br />® New Continuation Revision <br />C- Municipal J. Private University <br />D. Township K. Indian Tribe <br />0 ,R '>j,icn. ante:app ropdate lsuegs~ in noxfe=! <br />E Interstate L L'Mividual <br />~ <br />F Inlennuniapal M Profit Organization <br />A. Increase Award B. Decrease Award C. Increase Druation <br />G. Special District N. Other (Specify) <br />Duration Other(specity) : <br />D <br />ecrease <br />D. <br />9 NAME OF FEDERAL AGENCY: <br />14aLional Park Service, Southeast Region <br />(D CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: <br />1 DESCRIPTIVE TITLE OF APPLICANTS PROJECT: <br />1 5 - 9 1 <br />Byrd Optimist Park <br />Soccer, walking trail, picnic area, <br />TITLE: Outdoor Recreation, Develop and Plann <br />restrooms, and parking. <br />2 AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.) <br />Lee County <br />13 PROPOSED PROJECT <br />14 CONGRESSIONAL DISTRICTS OF: <br />Start Date Ending Date Ia. Applicant <br />b. Project <br />Oct. 2005 Oct. 2006 3rd <br />L10 IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br />15. ESTIMATED FUNDING: <br />ORDER 12372 PROCESS? <br />a- Federal <br />$ - <br />175 <br />430 <br />a. YES. THISPREAPPLICATION/APPLICATIONWASMADE <br />_ <br />, <br />2372 <br />00 <br />AVAILABLE TO THE STATE EXECUTIVE ORDER 1 <br />b. Applicant <br />$ . <br />20,430 <br />PROCESS FOR REVIEW ON. <br />c Slate <br />$ <br />DATE <br />d. Local <br />$ <br />b. No. ❑ PROGRAM IS NOT COVERED BY E O. 12372 <br />TATE <br />$ 00 <br />ErOR PROGRAM HAS NOT BEEN SELECTED BY S <br />e. Other (In kind) <br />FOR REVIEW <br />I <br />$ <br />ncome <br />I. Program <br />17 15 THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />TOTAL <br />g <br />$ <br />❑ Yes It "Yes," attach an explanation- No <br />350,860 <br />8 TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIONIPREAPPLICATION ARE TRUE AND CORRECT, THE <br />NG BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br />DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNI <br />ATTACHED ASSURANCES IF TI{E ASSISTANCE IS AWARDED. <br />a. Type Name of Authorized Representative <br />b. Title Chairman <br />a Telephone Number <br />Herbert Hincks <br />d <br />(919) - <br />d_ Signatur o ed Re <br />e. Date Sig ed <br />Previous Edition Usable <br />Authorized far Local Reproduction <br />I Stan rd Form 424 (Rev. 7-97) <br />Prescribed by OMB Circular A-102 <br />