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Type of Organization: <br />• Government <br />&/Non -Profit <br />• For -Profit <br />• Local housing authority <br />• Tribe <br />PROJECT CONTACTS <br />Name of Organization Director: David Sturgell <br />Phone: (509) 929-3258 <br />Email: seasparrow32@gmaii.com <br />Project Contact Name: David Soltz <br />Title: OFLHP Board Member, Lodge 20 Noble Grand <br />Phone: (570) 204-7893 <br />Email Address: dlsoltz@gmail.com <br />Fiscal Contact Name: Raven Harlin <br />Phone: (509) 962-9768 <br />Email Address: cemeteryioof@fairpoint.net <br />AUTHORIZATION <br />Acceptance of this application may be subject to subsequent compliance reviews, including a review <br />of the latest audit of financial statement. Preparation of an application does not guarantee that <br />applicants will receive funds. By signing this grant application form the undersigned certifies that all <br />information is accurate to the best of his/her knowledge. <br />28 November 2023 <br />Signature of Authorized Representative Date <br />2of9 <br />