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1. <br />A. <br />B. <br />C. <br />E. <br />IL <br />A. <br />CDBG 2013-2014 <br />APPLICATION FORM <br />DUE DATE: 5:00 p.m., January 16, 2013 <br />ORGANIZATIONAL <br />Department Name; Paint Your Heart Out Inc <br />Program/Project Name: Santa Ana Paint Da <br />Mailing Address: 1260N. Hancock St. Suite 103, Anahein <br />Contact Name: Connie Stewart <br />Title; Administrative Assistant/Bookkeeper <br />Telephone; 714 970-1150 <br />Fax: 714 970-1387 <br />E-Mail: connle@pyho.org <br />92807 <br />SERVICE AND FUNDING <br />Identify which eligible activity is being proposed. (example <br />Basic Eligible Activity (c) Public Facilities and <br />Improvements. <br />B. Identify which national objective will be met. <br />13.1. If Area-Benefit, identify the boundaries of the service area. <br />B.2. If Limited Clientele-Presumed Beneficiary, Identify the <br />presumed beneficiary category and the estimated number <br />to benefit from the service <br />B.3. If Limited Clientele-Greater than 51 % Low-income (LI), <br />Identify the estimated number to benefit from the service <br />and of those the percentage expected to be low-income <br />B.4. If Low-Income Housing, Identify the estimated number of <br />housing units to be filled with low-income households. <br />B.5. If Job Creation/Retention, identify the number of job <br />created and/or retained for low-income individuals <br />C. Indicate the CDBG funding amount requested. <br />Basic Eligibiity (c) Public Facilities and <br />Improvements <br />? Area-Benefit <br />? Limited Clientele-Presumed Beneficiary <br />® Limited Clientele-Greater than 51 % Low-Income <br />? Low-Income Housing <br />? Job Creation/Retention <br />Presumed Beneficiary <br />Estimated People to be Served <br />15 Estimated People to be Served <br />100% Estimated Percentage of People who are LI <br />Estimated number of Housing Units <br />Created <br />Retained <br />$70,0oo t S,c?vn C4, G;;<y <br />2 <br />75B-77