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9. National Objective. <br />10. Annual Project <br />Budget: <br />11. Project Beneficiaries: <br />® Principally benefits low- and moderate -income persons or households. <br />CDBG $84,503 <br />CDBG Program Income $ <br />Other Federal $ <br />Other State $ <br />Local Public $ <br />Private $ <br />TOTAL $84,503 <br />(N) # of persons - new or continuing access to a service: <br />p U . <br />i(1) # of persons - improved access to a service: <br />J........... ... .... <br />(S) # of persons - service that is no long substandard: _ <br /># of Persons <br /># of LMI Persons <br />12. How were the numbers of beneficiaries <br />determined? <br />13 <br />LMI Percentage <br />® LMI Limited Clientele <br />Street address, city and zip code of primary location of subrecipient services (if different than 4.): <br />14. Certification of Chief Administrative Official: The information provided in the application is true and <br />correct to the best of the government's belief and knowledge and it is understood the state may verify <br />information, and that untruthful or misleading information may be cause for rejection of this application <br />or termination of any subsequent grant contract. <br />Signature <br />Print Name <br />`R <br />Date <br />Title <br />