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<br /> <br /> <br /> <br /> <br /> <br /> <br /> CDBG 2013-2014 <br /> APPLICATION FORM <br /> DUE DATE: 5:00 a.m., January 16, 2013 <br /> 1. ORGANIZATIONAL <br /> A. Department Name: Paint Your Heart Out Inc <br /> B. Program/Project Name: Santa Ana Paint Da <br /> C. Mailing Address: 1260N. Hancock St. Suite 103, Anaheim, CA 92807 <br /> E. Contact Name: Connie Stewart <br /> Title; Administrative Asslstant/Bookkeeper <br /> Telephone; 714 970-1150 <br /> Fax: 714 970-1387 <br /> E-Mail: connIe@pyho.org <br /> IL SERVICE AND FUNDING <br /> A. Identify which eligible activity is being proposed. (example: Basic Eligibiity (c) Public Facilities and <br /> Basic Eligible Activity (c) Public Facilities and Improvements <br /> Improvements. <br /> i <br /> ? Area-Benefit <br /> ? Limited Clientele-Presumed Beneficiary <br /> B. Identify which national objective will be met. ® Limited Clientele-Greater than 51 % Low-Income <br /> ? Low-Income Housing <br /> ? Job Creation/Retention <br /> B.1. If Area-Benefit, identify the boundaries of the service area. <br /> B.2. If Limited Clientele-Presumed Beneficiary, Identify the Presumed Beneficiary <br /> ~ <br /> presumed beneficiary category and the estimated number <br /> to benefit from the service Estimated People to be Served <br /> B.3. If Limited Clientele-Greater than 51 % Low-income (LI), 15 Estimated People to be Served <br /> Identify the estimated number to benefit from the service <br /> and of those the percentage expected to be low-income 100% Estimated Percentage of People who are LI <br /> B.4. If Low-Income Housing, Identify the estimated number of Estimated number of Housing Units <br /> housing units to be filled with low-income households. <br /> i <br /> j <br /> B.5. If Job Creation/Retention, identify the number of job Created <br /> created and/or retained for low-income individuals Retained <br /> C. Indicate the CDBG funding amount requested. $90,000 + sxn'o ~ oaf Cdy N'OAVIA,,• OAO <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 2 <br /> <br /> 75B-77 <br />