I, ____________________________________(print name)have reviewed, understand and agree to all requirements and certify that this application, and any attached documents, are accurate. Applicant Signature _____________________________________________________ Date ________________ A check will be sent to you Jefferson County Fire Districts from Lake Chinook Fire & Rescue Crooked River Ranch Fire & Central Oregon Jefferson County Fire #1 Defensible Space Grant Rescue Intergovernmental Council 765 S Adams Dr, 11700 SW Graham Rd 6971 SW Shad Rd, 334 NE Hawthorne Ave. Madras, OR 97741 Culver, OR 97734 Terrebonne, OR 97760 Bend OR 97701 Phone:(541) 475-7274 Phone: (541)-629-8911 Phone:(541) 923-6776 info@lakechinookfire@rscue.org For Official Use Only Date Received Application Requirements Met Yes No Approved Funding Source__________________ Award Amount __________________
I, ____________________________________(print name)have reviewed, understand and agree to all requirements and certify that this application, and any attached documents, are accurate. Applicant Signature _____________________________________________________ Date ________________ Jefferson County Fire Districts A check will be sent to you from Crooked River Ranch Fire & Rescue 6971 SW Shad Rd, Terrebonne, OR 97760 Phone:(541) 923-6776 Jefferson County Fire #1 765 S Adams Dr, Madras, OR 97741 Phone:(541) 475-7274 Lake Chinook Fire & Rescue Defensible Space Grant 11700 SW Graham Rd Culver, OR 97734 Phone: (541)-629-8911 info@lakechinookfire@rscue.org Central Oregon Intergovernmental Council 334 NE Hawthorne Ave. Bend OR 97701 For Official Use Only Date Received Application Requirements Met Yes No Approved Funding Source__________________ Award Amount __________________
2018-jefferson-county-fuels-reduction-application.docx