The recipient entity's physical address:
           12292 Jackson Road
St. Francisville, La 70775

The recipient entity's mailing address (if different):
           Post Office Box 1922
St. Francisville, La 70775

Type of Entity (for instance, a nonprofit corporation):  Non-Profit Corporation

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

The last four digits of the entity's taxpayer ID number:  1496

What is the dollar amount of the request?  $25,000

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:
           Kevin Cheatham< Chairman

Provide a summary of the project or program:
           Matching funds to provide public transportation

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $15,000
          Professional Services. . . $5,000
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $5,000
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $0

Does your organization have any outstanding audit issues or findings?  No

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

What is the entity's public purpose, sought to be achieved through the use of state monies?
          To provide public transportation in rural West Feliciana Parish

What are the goals and objectives for achieving such purpose?
          To get people to doctor appointments, dialysis treatments, grocery shopping etc.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           We are currently providing service through DOTD but we need matching funds to run the program

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:
                 N/A
    
     (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:
                 N/A

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

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

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: 
               N/A

(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:
               N/A

          Provide the name, address, and office of the official to whom the person is related:
                N/A

          What is the nature of the relationship?  N/A

(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:
                 N/A

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               N/A


Contact Information
name:  Sherrel W. Johnson 
                                       address:  Post Box 1933
St. Francisville, La 707756
                                       phone:  (225) 635-6719
                                       fax:  (225) 635-3705
                                       e-mail:  sjohnson@wfparish.org
                                       relationship to entity:  Director