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EXHIBIT ''A'' <br />CLTAC: Application for Lodging Tax Grant Funding <br />Grant Application <br />Workshop - 2019 * <br />Dd you attend the Sant Application \ ,brkshop ' 2019 hosted by the tfttitas Oarnty Oranier of Conrrerce? <br />G Yes <br />CNo <br />G Yes, <br />I have read and undersland Slbrittal hstructions and General lnfornation for the 2019 Lodging Tax Gant Funding <br />Ffocess <br />Submittal lnstructions <br />& General <br />lnformation * <br />You are strongly encouraged to compose your responses to the questions of this form with a desktop text <br />editor and save your work, then copy and paste the information into the form. You may also save a draft by selecting <br />the button at the bottom of this page. When you do this you will be logged out and must log back in to continue. ln order <br />to save a draft you will need to provide an email address and a password. After completing the save draft, you will be <br />redirected to landing page containing a link to log back into the form. We suggest you save this link as a bookmark. The <br />link will also be sent to you in an email. <br />Organization I nformation <br />Name of Organization* Gallery One Visual Arts Center <br />Organization Address * $reet Address <br />408 N Pearl St <br />Address Line 2 <br />oty <br />Ellensburg <br />Fbstal/Ziptue <br />98926 <br />Upload Proof of <br />Organization Status <br />State / Flovinee I Region <br />WA <br />Ocuntry <br />US <br />Website wrrv.gallery-one.org <br />91 -08501 95 <br />1 92-003-555 <br />Federal Tax lD #* <br />UBI #* <br />Organization is a: *O Government Entity <br />ri 501(c)3 <br />C 501(c)4 <br />C 501(c)6 <br />C Other <br />(Note: you must submit 501(c)3, 501(c)4, or 501(c)6 approval documentation.) <br />Click here to viewsample documents (redacted). <br />GalleryOnelRS-1.jpg <br />Acceptade file fornats include: JFQ FF or llFF <br />* <br />Contact lnformation <br />Last Name *Miller <br />1.31M8 <br />First Mme*Monica