COMMUNITY BUDGET SUBMISSIONS 2013/14
Closing Date for Applications – Monday 6 May 2013
LATE SUBMISSIONS WILL NOT BE ACCEPTED
Allocated Funds:
A maximum total of $20,000 has been allocated for capital projects
A total of $20,000 has been allocated for operational projects – capped at $2,000 per organisation
Name of Organisation
Postal Address
Contact Person
Name:
/Position:
Telephone:
/Facsimile:
Email Address:
/Signature of Authorised Person
Financial Request
Does this request for financial assistance relate to a capital project or an operating contribution?
£ Capital £ Operating
Type of assistance required?
£ Cash £ In-Kind £ Machinery and or Labour (Please circle)
Please provide the date that the funds or in-kind assistance is required.
Month ______£ 2012 £ 2013
Project Outline:
ie. What is required, what are the benefits to the community, what are the disadvantages to the community if the assistance is not approved?
If your request requires works to a building or premises, please indicate who owns the building or premises and the land that it is situated on.
Shire of Moora - Community Budget Submission 2013/14
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Estimated Project Costs & Funding Sources
Please specify and name source of funding, and attach full details of expenditure, with supporting quotes where applicable.
Project Title:Organisation Name:
Income / Expenditure
Item / Cost/Description / Amount (ex GST) / Type / Description / Amount (ex GST)
TOTAL INCOME /
TOTAL EXPENDITURE
Please attach to this application the following:
· Any additional information that you believe will assist this application;
· Quotes that support dollar amounts of the project (two quotes required for submissions over $1,000);
· Plans or diagrams that illustrate your request.
Office use only
Budget Submission Approved: Yes £ No £
Acquittal Required: Yes £ No £
Shire of Moora - Community Budget Submission 2013/14
Page 2