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ILLINOIS CI.P�1N AND BEAt1TIp�, <br /> APPLICATZON � <br /> and Address of Local Government: Local Goverrune�t FEIN �; <br /> �i�v nf Decat �r 3]� 11L.A .n <br /> r;vi r (:pntar P1 ��� <br /> no�ati�r Tl Fi75�'3 <br /> County: Macon <br /> Project Duration: <br /> eeginninq: ()�.tnhar 1 � 1___qAq <br /> Endinq: 1„n_p��� � q�_ <br /> Duration: Ninea Months <br /> i Program Contact Person: Chief Elected Official: <br /> NdiT12: i.inrla i.rn},•_.,•+• Ne'11f1@• <br /> 2'itl@: � �-�r�_�nr��renn <br /> Rsron>>t i��cili ror tnr Tltl@: <br /> Street: �(�� F Nnrrl, C���� Str@@t: <br /> _1 r;.,;,. re.,�er <br /> City: no_�.r, T City: no��r,�,- p� za <br /> State: <br /> �? ��S�3—_ State: <br /> Phone: (?17 ) ��,�g,�n Phone: �'1��3 <br /> �?.1.Z) ���_�Rni <br /> Keep America eeautiful Certification: Leqislative Location: <br /> Certified Y State House District: <br /> Pre-Certified � n1 �r <br /> Other State Senate District: <br /> , Explain: <br /> S1er <br />, U.S.2�Q�ressional District: <br /> Status of Proposed Flindinq: <br /> GOURCE OF FUNDS AMOUNT <br /> Clean � Beautiful Proaram Grant $_ 7 , 000 <br /> _Glean Go m ya FLnr�a 3 7 . 000 <br /> _ ; <br /> ; <br /> � <br /> Total Proqram FVndinq: s 14, Qpp <br /> To the best of my knowledqe and beliaf, data in this application are true and <br /> correct, th�document ha8 bee� duly authorized by the qoverninq body of the <br /> applicant ..gr}� the applicant will comply with the attached assurancas if the <br /> applica T approved. <br /> —�,X�r 9/28/89 <br /> qnature of Authorized Official Title Date Signed <br /> II�PORTIINT NOTICB <br /> This state aqency is requesting disclosure of information that ia necessary to <br /> accomplish the statutory purpose as outlined under I11. R�v. Stats. Chap. 227, <br /> Par. 46.1 et seq. Disclosure oF this infcrmation is ltEQUIRED. Failure to <br /> provide any information will result in thia forai not boinq proceased. This form <br /> has been approved by th� State Forms Manaqea�nt Centar. <br /> 1 <br />