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5t29122, 10:52 AM f,yr,^ri bi+ ' ltLTAC Clerk Review <br />CLTAC: Clerk Application Review <br />Current Year Grant <br />Application <br />Workshop * <br />Name of <br />Organization * <br />Organization <br />Address* <br />Upload Proof of <br />Organization Status* <br />Street Address <br />10630 N Thorp Hwy <br />Address Line 2 <br />City <br />Thorp <br />Postal / Zip Code <br />98946 <br />PUNCH w9.pdf <br />Acceptable file formats include: JPG, PDF or TIFF <br />State / Province / Region <br />WA <br />Country <br />United States <br />450.62K8 <br />Did you attend the Grant Application Workshop for the current year hosted by the Kittitas County Chamber of <br />Commerce? <br />Punch Projects <br />Yes <br />No <br />Clerk Verification *Please confirm whether the applicant aitended the workshop or not. <br />Yes <br />No <br />Organization I nformation <br />Organization is a:*Business <br />Non-Profit <br />(Note: Please submit w-9 for business or IRS Designation Letter for non-profit.) <br />Click here to view sample documents (redacted). <br />Project Contact I nformation <br />First Name*Justin <br />lf-app-16-03.co.kittitas.wa.uslForms/form/submission/historyi7761 8/85645?hideHeader=true 1t17