The recipient entity's physical address:
           *** Confidential Address ***

The recipient entity's mailing address (if different):
           klfhjk

Type of Entity (for instance, a nonprofit corporation):  Association

If the entity is a corporation, list the names of the incorporators:
          ful;fhjklhj

The last four digits of the entity's taxpayer ID number:  1554

What is the dollar amount of the request?  $54,545

What type of request is this?  General Appropriation

Is this entity in good standing with the Secretary of State?  Yes

Provide the name of each member of the recipient entity's governing board and officers:
           sykdyjk dykdfg kdg hmdgh

Provide a summary of the project or program:
           dg hkdgh kdfgfkty mdghm dghm tg

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $30,000
          Professional Services. . . $7,000
          Contracts . . . . . . . . . . . $12,000
          Acquisitions . . . . . . . . . $8,500
          Major Repairs . . . . . . . $8,000
          Operating Services. . . . $15,000
          Other Charges. . . . . . . $7,000

Does your organization have any outstanding audit issues or findings?  Yes

If 'Yes' is your organization working with the appropriate governmental agencies to resolve those issues or findings?
          Yes

What is the entity's public purpose, sought to be achieved through the use of state monies?
          fhsrf jrftyj dghjmdg hm

What are the goals and objectives for achieving such purpose?
          dg ykdghjm dghm dghm

What is the proposed length of time estimated by the entity to accomplish the purpose?
           gkdgh kdghjd g

If any elected or appointed state official or an immediate family member of such an official is an officer, director, trustee, or employee of the recipient entity who receives compensation or holds any ownership interest therein:
     (a) If an elected or appointed state official, the name and address of the official and the office held by such person:
                 fgy jkfg kfhj,
    
     (b) If an immediate family member of an elected or appointed state official, the name and address of such person; the name, address, and office of the official to whom the person is related; and the nature of the relationship:
                 ryhulfhj, fhj

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 ,fg mfgm

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                  fghjmfghjmf

If the recipient entity has a contract with any elected or appointed state official or an immediate family member of such an official or with the state or any political subdivision of the state:
(a) If the contract is with an elected or appointed state official, provide the name and address of the official and the office held by such person: 
               fhul fhultujilghj, fhj

(b) If the contract is with an immediate family member of an elected or appointed state official:
          Provide the name and address of such person:
               ,y,g hj, fhj

          Provide the name, address, and office of the official to whom the person is related:
                ,r y, fghjmr yuk,

          What is the nature of the relationship?  fyj,f yj,fy

(c) If the contract is with the state or a political subdivision of the state, provide the name and address of the state entity or political subdivision of the state:
                 fyulk fyulfhj, gh,

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               ry, fhj,t il;t79 fym tymf g


Contact Information
name:  gkfg 
                                       address:  f hjkfg
                                       phone:  fgh
                                       fax:  hkdfgh k
                                       e-mail:  k fghk
                                       relationship to entity:  hkf ghjk