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-2- <br />2 <br />3. <br />CHILDREN'S TRUST FUND <br />FACE SHEET <br />Applicant Agency (with whom the contract is to be executed) <br />City of Mounds View ( 612 1 784-3055 <br />Legal Name ' Telephone <br />2401 Highway 10 Mounds View 55112 <br />Address City Zip <br />Director of Applicant Agency <br />Donald F. Pauley , Clerk-Admin(9trator <br />Name Title <br />Operati,q Agency if different from 11) <br />Same ( ) <br />Legal Name Telephone <br />CTF-I-A <br />Address City Zip <br />4• Program Director/Contact Person <br />Mary Saarion.IDirectoi Parks Recreation 6 Forestry <br />j612 one 784-3055 _.. <br />Name, Title - <br />S. <br />1 6. <br />7. <br />Fiscal Officer <br />Donald bra er F'_nance Director , _ ( 612 ) 784-3052 <br />Name, Title Telephone <br />Federal I.D. Number MN Tax I.D. Number <br />41-6008912 _ <br />=Qhai"`unc'_s_bv Spsir�a .. <br />�Or i:iiie �-uG-bin• <br />Federal <br />St,te - <br />County <br />Private (specify) <br />City 1,447.10 <br />Fees _ 4.026.00 <br />Amount'Requested from <br />Children's Trust Fund S 5.434.00 <br />TOTAL PROGRAM 110.906.00 <br />9034948 <br />Leave Blank, Official Use Only <br />Sequence Number <br />Vendor -Number <br />Amount Awarded <br />Date Received <br />Time Received <br />