SHIRE OF MOORA
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

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