ࡱ > _ z bjbj zt r=\r=\f B B B B B V V V 8 V + + + + + + + + $ M. 1 j *+ B " *+ B B ?+ R B B + + r t) T t* 0 R ) * U+ 0 + ) m1 < m1 t* m1 B t* | j ^ L *+ *+ R \ + m1 > : Cuming County 4-H Council Special Project Fund PO Box 12 West Point, NE 68788 (402)372-6006 Application for Donation to 4-H Club Application due for consideration on the 1st day of January, March, May, July, September, or November. Name of Club: _________________________________________________________________________________________________ Contact Person: ______________________________________________________________________________________________ Address: _______________________________________________________________________________________________________ Phone Number: _______________________________________________________________________________________________ Home Work State Purpose of 4-H Clubs Request: Include amount requested and specifics of how funds will be used.) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ List other sources of funding for use of request as described in the above: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ How many people will be affected by this project? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What are your goals for this project? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The information contained in this statement is for the purpose of obtaining funding from the Cuming County 4-H Council on behalf of the undersigned. Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and complete and that the Cuming County 4-H Council may consider this statement as continuing to be true and correct until a written notice of change I provided. The Cuming County 4-H Council is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein. If your project is chosen to receive funding, you must present receipts to the 4-H Council for reimbursements. ______________________________________________________ Name of Club ______________________________________________________ Signature of Representative ______________________________________________________ Date 0 7 8 ^ [ \ j k > J ( > : + ْٙzniaiaia hs h? 6 h? 6h? h? 6CJ aJ h? CJ aJ h? aJ hs h? 5aJ h h? hs h? hs h? 5 h? 5h? CJ aJ h? h? CJ aJ h? 5CJ aJ h h? 5CJ aJ he+ h? h? 5CJ aJ h h? 5CJ aJ j h? UmH nH u% 0 : O ] ^ [ \ = > ( > : + dh gd? gd? $a$gd? + f g h Z [ \ ^ c d e f h i k l n gd*@ gd~/l dh x gd? dh ^`gd? dh ^gd? gd? dh gd? ^ c d e f g i j l m o p r u v w x y z h / hHq j hHq Uh h h? OJ QJ h? h? 5hQg h? 5 n o q r u v w x y z gd*@ !D gd\ gd~/l 5 01h:p*@ / =!"#[$% @=;R Irui"0k?Z-Ԏ) Q K (pv Q R xzX[nPA^ *HK!EZhiJHo Io""E]"J*]tiw{Y{WyZI@ ui@mA Z"_ e`N1@"6LHI@{D ;(`_ܻ ˪\;>~ʣ&+/ SLMz)/@`a]K;,g5CHa(DHEɁPQDH#p6 #`(HBkgvF>6P ilGy),O"' &O D9W Fs.AG\T0I@DDz⢿ SaohB(? 0,bhDSݜpK,a p1! {{' 4=dEQ0a$\.#'"#*'DH"PJB\!&:p$" G"a0rSR-@) s:ţ0% X@!"B6NX +57 CHX;s'&&*!wa1,`@9z̢Q-~/^/P梺B"X'^&~6e&n_ ?ZЧJ!]N&Շ9 гeڊHs?c/R F8Y: %$U1;3"fzP?<i;`Om)k 1y 0Hw)OgAcp'~D< Bc0f' js,XLpX)z ϩX(`%4}aL'aM,B5$Wh8'{7aA H1l$$cŚQ o = p\ \N NuN>:` #!.4oCi97'M' 4]5.; `!y@r`X@7:UBHtJX5(a0wQ0E}.` ;CJ