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<br />County of San Mateo Office of Housing <br /> <br />5.3A'5 <br /> <br />Application for Funds FY 2005-6 <br />CDBG $ HOME $ ESG <br /> <br />I <br /> <br />PUBLIC SERVICE/SHELTER OPERATIONS/FAIR HOUSING <br /> <br />~ <br /> <br />Project Title: I <br />Project Location/Address: <br /> <br />I <br /> <br />Total Amount Requested under this NOFA: I $ <br /> <br />Type of D Public Services <br />Program: 0 Shelter Operations <br />D Fair Housing <br /> <br />I Total Project Cost I $ <br /> <br />Applicant Name: <br /> <br />Address: <br /> <br />Telephone: <br /> <br />Contact Person: <br /> <br />Telephone: <br /> <br />Name of Agency Director <br />(if different from Contact) <br /> <br />Name & Title of Person Authorized to Execute <br />Legal Documents with County for this Project <br /> <br />Fax: <br /> <br />Tax ID #: <br /> <br />Title: <br /> <br />E-Mail: <br /> <br />Beneficiaries - Part I. In the table below, please indicate, in the second column, the total number of persons <br />who have been served by your Program during the fiscal years indicated. Of the number of persons served, <br />indicate the number of families/households represented in the third column. Write un/a" if there were no <br />beneficiaries in these vears. <br />Fiscal Year # of Persons Served # of Households Served Did you Receive <br /> County Funds? <br />FY 2002-03 DYEs DNO <br />FY 2003-04 DYES DNO <br /> <br />Beneficiaries - Part II. . In the table below, please indicate, in the second column, the total number of <br />persons who have been served by your Program during the fiscal years indicated. Of the number of persons <br />served, indicate the number of families/households represented in the third column. Write un/a" if there were <br />no beneficiaries in these years. <br />Fiscal Year # of Persons Expected # of Households Expected Do you receive <br /> to be Served to be Served County Funds <br />FY 2004-05 DYEs DNO <br />FY 2005-06 DYES ONe <br /> <br />1 <br />