Laserfiche WebLink
City of Mounds View Nonprofit Relief Grant Program Application <br />Nonprofit Name: <br />Address: <br />Contact Person: <br />Taxpayer I.D. number: <br />Incorporation date: <br />FTE's as of January 1, 2020: <br />email: <br />5O1(c)(3) 5O1(c)(9) <br />Requirements <br />Yes <br />No <br />Applicant must be locally operated and domiciled in the State of Minnesota with a physical <br />establishment in Mounds View and/or Ramsey County with a demonstrated relationship with <br />Mounds View residents and businesses. Do you meet the above requirement? <br />Applicant must be a 501(c)(3) nonprofit organization or 501(c)(9) veteran's organization, religious <br />organizations are excluded. Do you meet the above requirement? <br />Applicant must be able to demonstrate financial hardship as a result of the COVID-19 outbreak, <br />please attach supporting documents. Are you able to demonstrate financial hardship related to <br />COVID-19? <br />Applicant must be in good standing with the Minnesota Secretary of State and the Minnesota <br />Department of Revenue as of January 1, 2020. If there is an issue pending with the Minnesota <br />Secretary of State, Applicant may still apply for the grant, but will need to demonstrate the issue <br />has been satisfactorily resolved in order to be eligible and receive grant funds. Are you in good <br />standing? <br />If required, Applicant must be licensed, in good standing. Are you required to be licensed? <br />Applicant must employ 50 or less full-time equivalent (FTE) employees as of January 1, 2020. Do <br />you have 50 or less FTE's as of January 1, 2020? <br />Applicant must have been in operation 6 months prior to application? <br />Applicant must disclose all federal, state or local grant or loan applications for which applicant has <br />applied, which has been received or remains pending at the time of application. Have you received <br />any other grants related to the CARES Act? <br />Applicant must Certify in good faith that the "uncertainty of current conditions makes the grant <br />request necessary to support ongoing operations. Do you certify? <br />Signed: <br />Title: Date: <br />The above information and attached documents are true and correct <br />Please attach a W-9 and other supporting documentation <br />