HomeMy WebLinkAboutDisaster Assistance Application DEM-131 (3)DISASTER ASSISTANCE APPLICATION DEM - 131
Application Identifier:State Number:
Federal Disaster Number:
Federal Catalog Number: 97.036 Title: Public Assistance Grants
Declaration Date:
Applicant’s FEMA Project Application Number:
Legal Applicant Recipient:
Applicant’s Name:
Street Address:
Mailing Address: County:
City: State: Zip Code:
Applicant Agent: Contact Information:
Name:Phone:
Title:Fax:
E-mail:
Signature:Date:
Alternate Applicant Agent:
Name:Phone:
Title:Fax:
E-mail:
Signature:Date:
Type of Applicant:
A - State F - Higher Educational Institution
B - County G - Indian Tribe
C - City H - Private NonProfit
D - School District I - Other (Specify) __________________
E - Special Purpose District
Enter Appropriate Letter _______
Congressional District Number:_______________________
State Legislative District Number:_______________________
Governor's Authorized Representative:
Signature_______________________________ Date:________________
NOTE: Shaded blocks for WA EMD use.
D20-189
4481-DR-WA
March 22, 2020
037-99037-00
County of Kittitas
205 W 5th Ave Suite 105
Kittitas
Ellensburg WA 98926
Judy Pless 509-962-7502
Budget Finance Manager
509-962-7687
judy.pless@co.kittitas.wa.us
September 1, 2020
Jerry Pettit 509-962-7557
County Auditor
509-962-7687
jerry.pettit@co.kittitas.wa.us
September 1, 2020
Do not fill this in
B
8th
13th