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MINNESOTA DEPARTMENT OF NATURAL RESOURCES <br />RURAL FIRE PROTECTION <br />1415 EAST HIGHWAY 169 <br />GRAND RAPIDS, MINNESOTA 55744 <br />RURAL DEVELOPMENT ACT OF 1972 - RURAL FIRE PROTECTION ASSISTANCE <br />APPLICATION FOR MATCHING FUNDS <br />INSTRUCTIONS: <br />1. Fill out form completely. <br />2. Attach additional narrative or other supporting material as <br />appropriate to better define your project and /or need. <br />3. Mail application and accompanying qualification questionnaire <br />to above address prior to January 22nd, 1983. <br />Fire Department Name: <br />Name of individual authorized to act <br />in behalf of Fire Department. <br />Street or Route: <br />Title: <br />City, State, Zip Code: County: <br />Business Phone: Home Phone: <br />(include area) <br />Descriptive Name of Project: <br />Project Budget Summary: <br />Federal Funding (50 %) <br />Applicant's Share (50 %) <br />Total Project Cost <br />Source of Applicant's Share: <br />Appropriations $ <br />Bond $ Other $ Explain <br />Other <br />The applicant certifies that to the best of his knowledge the information <br />on this application is true and correct and the applicant has the ability <br />and intention to finance and execute this project if a grant is approved. <br />Signature of Authorized Official: <br />Date Prepared: <br />�y <br />