NEVADA COMMISSION FOR For SHPO use only Received:_ CULTURAL CENTERS AND HISTORIC PRESERVATION Postmarked:_ GRANT APPLICATION FOR FY2017-2018 Delivery Svc.:_ Initials:_ APPLICATION COVER PAGE (This unaltered form must be submitted with the application.) Applicant Organization: EIN (Taxpayer Identification Number): Mailing Address: City: County: ZIP: Project Contact: Title: Daytime Phone: Evening Phone: Fax: Email: Project Title: Project Address: City: County: ZIP: Project Type: Rehabilitation/Construction Planning/Construction Study/Construction   Architectural/Engineering Historic Property Name: Date Built: Property Insured: Yes; please enclose one copy of policy No; please explain:   Project Synopsis (brief): Proposed Start Date: Proposed End Date: Project Budget Summary: Applicant’s authorized signature: Amount Requested: $ Proposed Match: Cash $ Name (please print): In-Kind/Donations: $ Title: Total Project Budget: $ Date: For SHPO use only: Award:
NEVADA COMMISSION FOR CULTURAL CENTERS AND HISTORIC PRESERVATION GRANT APPLICATION FOR FY2017-2018 For SHPO use only Received:_ Postmarked:_ Delivery Svc.:_ Initials:_ APPLICATION COVER PAGE (This unaltered form must be submitted with the application.) Applicant Organization: EIN (Taxpayer Identification Number): Mailing Address: City: County: ZIP: Project Contact: Title: Daytime Phone: Evening Phone: Fax: Email: Project Title: Project Address: City: County: ZIP: Project Type:  Rehabilitation/Construction  Planning/Construction Architectural/Engineering Study/Construction Historic Property Name: Date Built: Property Insured:  Yes; please enclose one copy of policy  No; please explain: Project Synopsis (brief): Proposed Start Date: Proposed End Date: Project Budget Summary: Amount Requested: $ Applicant’s authorized signature: Proposed Match: Cash $ In-Kind/Donations: $ Total Project Budget: $ Name (please print): Title: Date: For SHPO use only: Award: