The recipient entity's physical address:
           313 Martin Luther King St
Napolenville LA. 70390

The recipient entity's mailing address (if different):
           P.O Box 515
Napoleonville LA. 70390

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

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

The last four digits of the entity's taxpayer ID number:  8208

What is the dollar amount of the request?  $150,000

What type of request is this?  Capital Outlay 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:
           Shederick Weatherspoon
140 Daggs St. Belle Rose LA 70341
Albert Landry
4784 Sugar Hollow Lane
Addis, La 70710
Terrance Williams
121 Daggs St.
Belle Rose La. 70341

Provide a summary of the project or program:
           We respectfully ask for funding to support the completion of building restoration project. Funding will be used towards following areas:

1.Electrical work-Installation of wiring and fixtures.
2. Interior Walls: Completion, repair, finishing, and painting of walls.
3.Flooring- Installation completion of durable flooring throughout.
designated area of lodge.
Completing these improvements will allow the lodge to operate more effectively and provide a comfortable, safe and accessible environment forour members and the community.
4.Kitchen- Purchase and installation of appliances, sinks and related fixtures.
5. Restrooms- Installation of toilets, sinks, and other necessary restroom fixtures.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $90,000
          Professional Services. . . $10,000
          Contracts . . . . . . . . . . . $15,000
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $20,000
          Other Charges. . . . . . . $15,000

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?
          Not Applicable

What is the entity's public purpose, sought to be achieved through the use of state monies?
          Mount Moriah Lodge No. 17 is located in a rural area of Assumption Parish. The Lodge has been and is a pillar to the community since 1886. Our mission is to render service to the people of our community through unity and brotherly love and to assist in improving their cultural, social, and economic conditions.

What are the goals and objectives for achieving such purpose?
          Goal 1: Our goal is to complete renovations of lodge building and satisfy building code requirements for our town and Parish.
Goal 2: By accomplishing Goal #1; we will be able to continue to deliver quality programs as well as new programs to our Community. Our current programs are Back to School, Christmas Giveaway, and a Scholarship drive.
Goal 3: Our future objective will be to add WiFi and offer the building as an after-school location. This after-school location will allow us to provide these services to:
• Meal in the evening where the home may not be able to offer one
• After-school tutoring;
• After-school location to perform homework with Internet access
• Future college and vocational training searches
• Monthly programs of health and welfare.
• Partner with the Food Bank to offer free groceries on a schedule

What is the proposed length of time estimated by the entity to accomplish the purpose?
           1 year

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:  Shederick Weatherspoon 
                                       address:  140 Daggs St.
Belle Rose, LA 70341
                                       phone:  9855134145
                                       fax:  N/A
                                       e-mail:  slide2meluv@yahoo.com
                                       relationship to entity:  Worshipful Master