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METROPOLITAN COUNCIL <br />Suite 300 Metro Square Building Saint Paul, Minnesota 55101 <br />291-1571 <br />ISG-85-90 <br />REQUEST FOR PAYMENT OF GRANT-IN-AID <br />Metro Account Number: 621 0100 <br />Amount of Grant: >v)tl <br />Application Number: MD-01-6-N <br />Date Contact Sent: <br />Please fill in the info -oration below and return this form and four contracts, <br />all signed by an authorizing official, to Linda Hennessey at the Metropolitan <br />Council. Verification that the person signing the form and contracts is <br />legally authori:ed to bind your organization must be incl-ided. 'if a fiscal <br />agent is being used, checks must be made out to the fiscal agent;—fFeore, <br />ran*andaddress of the rlscai agent must be lnalcatea Wow. <br />Make check Da_vable to: <br />Name L41 ry OF 9WJ('25 //r71/ <br />JnUW 0— oti aniz on <br />',ddress aye / &Z&& AC /2. <br />City dl:�7-. AuZ _- <br />;tatr 2ip Code -V/�--- <br />Project Dates: <br />r z c a "Sig7ature <br />KM655A <br />0 <br />