PROVIDE EDUCATIONAL AND SOCIAL SERVICES FOR PRE-SCHOOLERS
~
-
I)
(
AGREEMENT
This Funds Agreement is made and entered into between the City of Clearwater, hereinafter
referred to as the City, and Pinellas County Head Start hereinafter referred to as the Agency,
'WHEREAS, it has been determined to be highly desirable and socially responsible to provide
educational and social services for pre-schoolers to those who would not otherwise have a means
to fill this need; and
WHEREAS, the City desires to help those in need by providing funding for the above services;
and
WHEREAS, the Agency provides such services and operates in the City;
NOW, THERFORE, the parties agree as follows:
ARTICLE I. TERM
The term of this agreement shall be for a period of 12 months commencing on the 1'1 day of
October, 1999 and continuing through the 30th day of September, 2000 (the Termination Date)
unless earlier terminated under the terms of this agreement.
ARTICLE II. RESPONSIBILITIES OF THE AGENCY
1. Services to be Provided: The Agency shall provide the above stated service in
accordance with the proposal submitted by the Agency and approved by the City, which
is incorporated herein by reference.
2. Area to be Served: Services rendered through this agreement shall be provided within
the corporate limits of the City as it now exists and as its boundaries may be changed
during he term of this agreement.
3. Scheduled Reports of Agency Activities: The Agency shall furnish the City Human
Relations Department, Grants Coordinator, with an annual report of activities conducted
under the provisions of this agreement within sixty days of the end of the Agency's fiscal
year, Each report is to identify the number of clients served, the costs of such service,
and commentary on the viability, effectiveness, and trends affecting the program,
4, Use and Disposition of Funds Received: Funds received by the Agency from the City
shall be used to pay for the above services as further described in the grant proposal
submitted by the Agency to the City. Funds existing and not used for this purpose at the
end of this agreement term shall be deemed excess to the intended purpose and shall be
returned to the City,
5. Creation, Use, and Maintenance of Financial Records:
tJ /J(j
Ie .
/' '\
( (/; !
/'J .
-
a) Creation of Records: Agency shall create and maintain financial and accounting
records, books, documents, policies, practices, procedures and any information
necessary to reflect fully the financial activities of the Agency. Such records shall.
be available and accessible at all times for inspection, review, or audit by
authorized City representatives.
b) Use of Records: Agency shall produce such reports and analyses that may be
required by the City and other duly authorized agencies to document the proper
and prudent stewardship and use of the monies received through this agreement.
c) Maintenance of Records: All records created hereby are to be retained and
maintained for a period not less than five (5) years from the termination of this
agreement.
6. Non - discrimination: Notwithstanding any other provisions of this agreement during the
term of this agreement, the Agency for itself, agents and representatives, as part of the
consideration for this agreement, does covenant and agree that:
a) No Exclusion from Use: No person shall be excluded from participation in,
denied the benefits of, or otherwise be subjected to discrimination in the operation
of this program on the grounds of race, color, religion, sex, age, national origin, or
disability.
b) No Exclusion from Hire: In the management, operation, or provision of the
program activities authorized and enabled by this agreement, no person shall be
excluded from participation in or denied the benefits of or otherwise be subject to
discrimination on the grounds of or otherwise be subjected to discrimination on
the grounds of race, color, religion, sex, age, national origin, or disability.
c) Inclusion in Subcontracts: The Agency agrees to include the requirement to
adhere to Title VI and Title VII of the Civil Rights Act of 1964 in all approved
sub - contracts.
d) Breach of Nondiscrimination Covenants: In the event of conclusive evidenced
of a breach of any of the above non - discrimination covenants, the City shall have
the right to terminate this agreement.
7. Liability and Indemnification: The Agency shall act as an independent contractor and
agrees to assume all risks of providing the program activities and services herein agreed
and all liability therefore, and shall defend, indemnify, and hold harmless the City, its
officers, agents, and employees from and against any and all claims of loss, liability, and
damages of whatever nature, to persons and property, including, without limiting the
generality of the foregoing, death of any person and loss of the use of any property,
except claims arising from the negligence or willful misconduct of the City or City's
agents or employees. This includes, but is not limited to matters arising out of or claimed
to have been caused by or in any manner related to the Agency's activities or those of any
approved or unapproved invitee, contractor, subcontractor, or other person approved,
Ad
I
I
authorized, or permitted by the Agency in or about its premises whether or not based on
negligence
ARTICLE III. RESPONSIBILITIES OF THE CITY
1. Grant of Funds: The City agrees to provide a total grant of$7,014,OO to fund the
program in accordance with this agreement and subject to City Commission budget
approvaL
2. Payments: The total amount requested will be paid by the City to the Agency within 30
days after execution of this agreement by the City and the Agency but no earlier than
October 1 of the budget year for which the funds are authorized.
ARTICLE IV. DISCLAIMER OF WARRANTIES
This Agreement constitutes the entire Agreement of the parties on the subject hereof and may not
be changed, modified, or discharged except by written Amendment duly executed by both
parties, No representations or warranties by either party shall be binding unless expressed herein
or in a duly executed i\mendment hereof.
ARTICLE V. TERMINATION
1. For Cause: Failure to adhere to any ofthe provisions of this agreement as determined by
the City shall constitute cause for termination. This agreement may by terminated with 5
days notice without any further obligation by City,
2. Disposition of Fund Monies: In the event of termination for any reason, monies made
. available to the Agency but not expended 'in accordance with this agreement shall be '
returned to the City,
ARTICLE VI. NOTICE
Any notice required or permitted to be given by the provisions of this agreement shall be
conclusively deemed to have been received by a party hereto on the date it is hand-delivered to
such party at the address indicated below (or at such other address as such party shall specify to
the other party in writing), or if sent by registered or certified mail (postage prepaid), on the fifth
(5th) business day after the day on which such notice is mailed and properly addressed.
1.
If to City, addressed to Grants Coordinator, Human Relations Department, P.O Box 4748,
Clearwater, FL 33758
Ed Dickey
Pinellas County Head Start
6698 68th Ave. ~orth, Suite D
Pinellas Park, FL 33781
2,
If to Agency, addressed to
ARTICLE VII. EFFECTIVE DATE
The effective date of this agreement shall be as of the first day of October, 1999,
/JtJ
,~
J
,
ARTICLE VIII. CONTINGENCY
This agreement is contingent upon inclusion by the City Commission of funding for the Social
Services Grants Program in the City of Clearwater Fiscal Year 1999/2000 Operating Budget.
,IN WITNESS WHEREOF, the parties hereto have set their hands and seals this
<.:i<..-
;;q dayof 0 c~ ~ ,1999,
City of Clearwater, Florida
Countersigned:
CITY OF CLEARWATER, FLORIDA
By:
M chael Roberto, City Manager
Approved as to form:
~~
Attest:
John Carassas, Assistant City Attorney
a E. Gou~~, City Clerk
-- -
Witnesses as t? Agency:
By: ~ -drr~
President
I(P~
~~ds:D
Attest:
~~~~
JY)
)
,
CITY OF CLEARWATER
SOCIAL SERVICES GRANT
PROJECT APPLICATION FORM
Phone: (727) 562-4060 for assistance
Due: June 7, 1999
A. Application Information
Applicant:
(Sponsor/Developer)
Pinellas County Head Start
Organization Name:
(If different)
Same
Address:
6698 68th Avenue North. Suite D
City; State; Zip
Telephone Number:
Pinellas Park. FL 33781
(72]) 547-5952
,
I
Contact Person:
Ed Oi ckev
Title:
Trainin~ Coordinator
Telephone Number:
(]27( 547-SgS?
Period for which funds
are being requested:
10/99 throuqh 9/2000
SignatUfe(?;:>~~ ~41"'1A.o
.-
/"
C@ I-H1,'e L, M a V' ~t-1aV'~
Board of Directors Chairperson
Date
~-Ll~ qq
NOTE:
The City of Clearwate~ reserves the righ~ to fund applicants at a
level lower than requested.
2
I
I
B. Activity (Check One)
Adult Crime
Child Abuse
Elderly
Hunger
Juvenile Crime
physical Illness
Parenting
Adolescents
substance Abuse
Unsupervised
Children
Youth Development
,
I
Other
(Describe Below) , X
./
3
)
I
C. AMOUNT OF FUNDING CURRENTLY REQUESTED:
(Not to exceed $10,000)
$10.000.00
D. SPECIFICALLY FOR WHAT WILL THIS MONEY BE USED.
(Line item budget for this amount)
Salarv for a Floatina Substitute Teacher:
Workers Como. @ .0260
Unemployment Compo @ .054
Health Insurance @ 167.00
Life Insurance @ 2.50
TOTAL
$14,123
367
Ib3
2004
30
$17 ,287
Salary
Head Start will provide matching funds of $7,287 federal funds from the
Department of Health and Human Services.
E. BRIEF DESCRIPTION OF PROJECT YOU WISH TO FUND UTILIZING THIS
GRANT.
The funds will be used to cay the salary of a Floating Substitute Teacher
to fill in when Teachers are absent from centers in Clearwater.
F. BRIEF DESCRIPTION OF YOUR OVERALL ORGANIZATION.
E.ine.11.qc: r.ollntY,bk><ld St<lrt ic; <I feder<llly funded child and family
c;prvi~pc; program. Head Start provides education. health services. nutrition,
c;o~ial c;ervi~es. mental health. parent involvement and other services to
3 <lnd 4 year old ch~ldren and their families.
4
I
I
G.
G.
NUMBER OF CLIENTS SERVED BY THIS PROGRAM.
320 in the citv of Clearwater.
H. PERCENTAGE OF THESE CLIENTS WHO ARE CITIZENS OF CLEARWATER.
100%
I. CURRENT OVERALL ORGANIZATION BUDGET (PLEASE ATTACH) .
$10.065.634
J. IF THIS IS START UP OR MATCHING MONEY, SPECIFY THE DETAILS
i.. e. :
WHICH AGENCY OR ORGANIZATION WILL PROVIDE THE MATCH, THE
REQUIREMENTS AND THE AMOUNT OF THE MATCH.
The total agencv bud~et is 10.065.634 and thp lO~ill m.qt~h ic: ?n~
or 2.013.127. This match is requirpd hy thp Fpdprill npp~rtmpnt
of Health and Human Servi~es(HHS)
Yes - Documentation 'i~ pn~loc:prl
We have five (5) ~pntpr~ lo~.qtprl in rlp~rw~te~
K. IS YOUR AGENCY A REGISTERED 501 (C) (3) NON-PROFIT AGENCY OR IN
THE PROCESS OF BECOMING ONE.
Yes - dOclJmentatior....i~ pn~loc;pd
,/
L. DOES YOUR FACILIl~ HAVE OR IS IT IN THE PROCESS OF ACQUIRING
THE APPROPRIATE LICENSURE FOR THE DELIVERY OF THE SERVICES
DESCRIBED IN THIS APPLICATION.
All of Head Start's. centers are li~pnc;prt hy thp PTnplhc: Co"nty License
Board.
5
I
I
M. HAS YOUR ORGANIZATION RECEIVED OR IS IT EXPECTING TO RECEIVE
FUNDING (WHETHER CASH OR IN-KIND CONTRIBUTIONS) FROM THE CITY
OF CLEARWATER DURING THE FISCAL YEAR FROM OCTOBER 1, 1999
THROUGH SEPTEMBER 30, 20001
YES ---X-
NO
IF YES, PLEASE EXPLAIN:
The City of Clearwater donates a building and space for our Clearwater Center
lnr~+t:lti ~T 7nl NQy.th Mic:cnllr; Au,:anll~
6
SEOlON C. NON.FEDERAl RESOURCES
1.' Clan. P,oo,.m Ibl AoDllCM>1 leI S~Le Idl ov- Saute" Ie, TOUlS
PA 22 s s s 2,013,127 s 2,013~127
PA 20 0 0
..
-
TOTALS hum ollonu 8 ~nd II' S S s 2.011.127 s 2.011.127
SECTION D . FORECASTED CASH NEEDS
,-
T..... ,.... ,., ,.... '" 000aIt.. lowI ~t1.. ',d 0...".. .... 0.......
3~J
S 8,052,507 s 2,013,127 s 2,013,127 52,013,127 s 2,013,126
Honf~c:kr~J 2,013.127 503,2~2 503,282 503,282 503,2B1
TOTAL hum 01 I,nl!\ l]~nd 14' S 10.065634 s 2.516.409 s 2 516.409 '2,516,409 , 2,516,407
SECTION E. BUDGET ESTIMA res OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Gr.nl Program 'UN" ru.eo.c; "a.oo"h~tl
Ibl fi,., lei Se(Dnd Id, Third leI Four1h
PI1 ?? S 8.180.280 , 8.709.204 , 9.219.259 ' 9.701 222
PA 20 74,852 78,595 &2,525 86.651
-
.-
TOT AlS hum oll,ne, 16 .191 , 8,455,132 , tl,tl77,~89 s 9,321.7~4 '9.787.tn1
SEcnON F. OTHER BUDGET INFORMA lION
(Anuh .dd,tlon~1 Sheen., Ne1.tnoi'y'
O,,~ct C)u'9u: IH. Indit.ct (Jurgu:
.,
~'m~,lu
.
Authorized lor Loc;al r
lducllon
Sf .2.^ ,..... p",1" 7
p,">IJ'tloI<I by 0U8 ~LuLat A.IU7
-----, .... ...,1""M.IIUil - i'Ufl-LOnSUUCLIOn i-'rograms
Sf C110k A - IUOGrT SU'.U.lJ.n
Gr,nt ~r'", ClUb; of f~,,1 En;"."tr-d Ur'oOCl~t~ Fundl .._ or ..,.,;~ ~
f un<1.on Ootn.,rtic It I sjJU nQ
or Activity "~m~r F~r..1 "on-I~rll I fl'6erAl /IiOI'I-I ~ r aI Tout
("I Ib) It) ldl It I (f) IljI)
S S s 7,981,219 s s
I PA 22 1,995,305 9,97b,524
PA 20 I I I 71,2tlti 17,t522 89,110
I I I I I I I
I I I I I I
I IS - 11S n n h c:; h ~ LJ
S S s
,iIilIII'LS H nc:;, S07 , n1 ~ 1 ;> 7
SECTlOIt 1- IU:xitT U. T( GOlUB
Ill) o IU.J(T "cc'-U( J\)<TIOoo CIA W;~ I Toul
O~ct aUl (Jttgor;"s PA 22 1121 PA 20 1m If.) 151
.... ~non~1 Is 4,939,510 Is Is s Is 4,939,510
b.. fri~ kntfin I 1,740,725 I I r I 1,740,725
to Tr...-tl I 25,921 I 7,450 I I I 33,371
It Equipmtnt I I I I I
t. Suppl~s I 207,721 I 2,000 I I I 20g.721
f. ContrI~1 I 71,t5~5 I 9,020 I I I t50,90J
,
- I I I I I
~ Con rtn.r<l >Of'l
h.. 01l'~ r I 995,457 I 52,C51t5 I I I 1,04~,275
i.. TOUI Oirect CNr~s hum 01 (". 6n) I 7,9t51,219 I 71,2btl I I t5,052,507
~ Indirect OI,,9ts I I I
-
L TOT AU h~m 01 6, ..nd I>J) S S S s Is
, .
,; ... . - . .':---:---:==--=.-:0 -..- . . . - ......
. .. ~--..;. ...-.---- .
' . . .. ..
"'091.11'1I In(omf
~Is
I
Is
I
Is
I
Is
Is
Authorized for Local Reproduction
Sa~Cl ~orm '~'A ,....,
P,nc~ tor 0U8 c.a.- A-1C2
:-
-
. -.
-----. .. . I _'....,.,'''-'',\ - '''.;jl-....Url~\.i uC'LIOn rrograms
Sf ClIOIC A -8UDGtT SU"U.,u,llY
Gro'" hO<jlr. m ~ulog of F.Mr.1 In;,,utr-d UnoOl~tptf Fur-dl I M_ Of l.....;'-f-d ~
f un<1.Otl Ootntrtic AU;fUncl
0< "c1 iwity Humber F.o.r.' "cwH~r.1 I f~r.aJ MO^-h.6Pr.1 I Toul
I.) Ibl lei (d) (el II) IQ)
S s I s s I s
I I I
I I , I
I I I I I
I - I s Is I
5 S IS
-1iIIIW
SlCT10"" - BUDGET (). TEGOllllS
I OIUJo(T -xu.w 'lI..cnooo 01: A.:;~ I Toul
Ob;40c1 Clus ~t"9or~1 1(1) PA// 1m PA :::>0 1m (4) I (SI
... ,."n.on_1 Is 15 Is 15 1$
b. Fri~ hn..frtl I I I I. I
c.. Trlrtl I I I I I
c.. l quipmrrrt I I I I I
!. SU;lP{~S I I I I I
f. Contr.cnul ~
~ TOTALS hum 01 6, .nd 6J)
157,981,219 .
571,288
15
-'~~=~~.-.;;-: - -".:.. : ".: ... ': -. .. - ~-'.- . - '-"'" ...:...
I /),O~2,507
I
I
I b,052,507
I
I $8 , 0 5 2 , 5 0 7
7,9/)1,219
71,288
IlIII(!!P, nrvnior&
n. Ot~r
i. TouI Oir..ct Chlr9t1 hum 01 Eo.. 6h)
7,9/)1,219
71,288
~ Indirrct Ch'r~s
".. & .-' .. ,- .- -..: . '-.. ..-.-. - - ._----..~~.. --~"",:'-~.. -
"'O<jII.m Incorn..
; Is
Is
Is
Is I
S...-.e..o ~orm '?'A ".1111;
P..-.c' otJood 0., QUa c.::.,.., A. 1 C 2
Authorized for local Reproduct-ion
,,-.-,.- --,
,. .
;..r' ,
,. J, "
.~~. .
.I .1 ~ .. ,.;"
~:~:1. .,.j
... '_ Pllo__
I
I
@)o~(j'li~ @)fi[j'@@n@I? . . .
. .
", .i i
Internal ~euenue SeYllicQ -; .~.-;
. r .
~)": FE B 0 9 '19Tl \ 1n ..~ ,~r_ ta: .
720-z~ Fi:I:rlc~
. (904) 791-2636
-'
- ...:..:-
....
.-
'. .....\..
., .
'j-
, .
. ': ... . . ..... :
r~ 11ead St':trl:. O1ild Dev.~~opcD81lt. & F(J':1ii~.
'. . Scrvicc:~~ ):nc.. " :.:. :..' ~. .'
'. ".~ ..~., , " 1.2351 - l:.u.t:l\ ^vC':m.\~ 11orth.: ._;~:t~'
, ,.:;; ,:.:. .'::;/~~L.;L:. '.. ' .' ;::. '., :.':!/'~'~: . .;,: ~':: .~ _ )~:::o. Fl~da 33540 :. ..\::;: .' , - ::. '?t
" ..,.' .., ,.;.~.. ': . . ,.; '., " j; .' '. ..:'~}i.~...: :;.: ~ ,~~~
),\..'/~:;jir:.; ::~. . . ; '<:. ; .:;:.H.t 'u ;/::::.. .', :;r' . . ::, t::.':: ' :i;i
'''~.~,::.:'':'.'::::. Dear Applicant:: .~,:,:":..., . . ....... . . :. ~~~~
/"';:';':J:(':i~:~;i/' B~~~d o~ ~~;6;:;';a tio~ "~~p;lied, and :~~~'lDin~ yOur opo~ ~~o;;': ym. ' .. /:;~
.:/',:.;'.:';:Hbe as stated in your application for recor.nition ,,1' exemption. we . . ..;"
, . l~. ...,~..:~:.':;:\' have dotormined you are exempt from Federal incolU6I -tax \mdar sectr'6n. .- ~
:' '. .:'.....~..:.:~: 501 (c) (3) o~ the Internal Revenue' Code. . '. ...~.:. . !:.... . ::: :;.:-
'~.~::~."_f.:-::.'::;,:., .:.:: '. ." ::: .-.:.... : .... ....... ':": . . ." .: ~,
'. .':.; :::' t:,'~,{::, : ': We 'have further determined you are not a pJ'i.va'lo foundation' irithin <~:.-
. .' ': ":,>i the meaning of section 509 (a) of the Cauo, uccaus~ you arc,.'tn .'. ;...'.....
. ,~. ,:"'.~ ~organi:.z:ation describeain' section 509 (,,) (1) &l}O (h) (1) (I\.) (vi) - ...J -
'... . .' ..-;..
: '
. ...
.'.
. . -;. .. .... . ,.! . .::.. . . .' .... :'. .
I'.. ....... ":"You:aro 'not liablo"fo'r so~i;l socurity (FJC.q -taxes lmless.y?:J.
. .... .::: "': .filo' a waiver o'r' oxomption cortifica te an provided in tho Federal
'" :.' ',..:.:i:':Xnsurarico .Contributions Act. You aro not liable. fc.-r 1.1\0 taxos i1llflo,ed.
". ..;.. '''under: the 'Federal Unemployment Tax Act (rUTh). - ..,.....
." . .:....i.;~..!. . ..... .,:":....' .', ';'.>' . . . -:'., . ' .>". . . ...:.'~'<
. . ::' ::.~. '.::'.' . Since you arc 'not a: priva to found a lion, yon ...rei nett !:\lbj e;ct t()
.' I.... .
.> .~:~ ~ the oxoise taxes under Chapter -12 0 f tho 'Co.tlo. llowever. )'c.\1 arc not
. .... l, f .
. .... :.:; 'automatically exempt rrom other Fe;doral oxcisEt' taxes. 'If yc,u have- any
'.;' .~:' .:: .:,;. questions about excise, employment, or other Federal taxes.. pleas&
. . .' ...::,....~:1ot us know. .." ... .'
~.;-.~
. . ~
.. ,,"~ .=,
, . ...
. .-.J ,~
.::~ .:: .....
. .'
. ....
.e. ..-:.:;..
. -.t "-
. . r-:t:.
...
- . ..:.
. ' ,
.'
. .
. Donors may deduct contributions to you as pro~ded in section
.' 170 of the Code. Bequests, legacies, devises. transfors. or gifts to
. '. you or for your us~ a:--e deductible for Federal cs'ta:te and l;i~t' ta."'C .
purpo5e~ i.f they meet the applicable provisions or sections 2055.
2106, and 252~ of tho Code.
'.
..
-
.~
..
. . If your purposes, character. or raethod or opero.tion is changed..
please let us know so we can con~idor tho effect or tho change on
your o~empt ~tatu9. Also. you.should infoDn us or all changos in your
name or address.
.,
....
I.
..
-
- .
(0"..')
Form l-178 (R~. 8-
:
. . _, ," ",..r.'_, . . . .
~.' '.> .; If your"gross f.~ceJpts each year' arc normally- rnOlij than $5.000..
..' you are required to filIForm 990, Return of Or~anizat on Exempt
From Income Tax. by the 15th day of the fifth month a.fter tho end
of' your annual accounting poriod. The law' imposes a penalty of" SIO
a day. up to a maximum of ~5, 000, for failu 1"0 to filo a roturn on Hmo.
. . You 'are not required to file Federal incoiilo tax returns unless
you are subj eet to the tax on unrelated. businuss inccalEl under section,
511 of' the Code. If' you are subject to this tax, you ~ust fila an 1ncom~
, t~ r'eturn .on Fonn 990-T. In this lot tOl' \YO ,lro ncd. c\etorlllining whether
any of you~ present or proposed activitios CifO unrelatod trade or
bm~iness as defined in section 513 of tho Codo.
. ., ,.' .
. ; ~ .
-', .
. "
.
" .
, '::'.:', ", You. need an employe!" identification numbel' oven j,f' you havo no.
'employees.,.;rf. an omployer idonti.d.cation l1\\r.lbOI' WetS not onto roo on.
. ., 'your application.' a number will be assi~nod to ~'o\\ nud' you will bET
.: I . ;' advised of it. Ploase uso that number on il11 I'(Iturns yo\.\ rile nnd in.
. :': ,:,'all corrospondence with the Intornal Rovol1uo SOl'vico ~
, .'
. . ::'":~?:: ~.:'" . .... ,. -
. ." 5'," , I. PI ' 1
:->. . ';'..,.::L.::'~'. ease coep this determination lottoI' in your' pormanont. records_
. .,. ,", .
: ';~'?f::J:f;'<.' :': ~:;. :(:." ",
-."::'.~",,'~.".~I:.",'... ....:. :"": .....
. . . . , ;:.
,~.. ....:. ...~~...'..;;i..~:~.~..-..:..::.:.r ~'~: :::; '.:;~'~ :<-.' ;. . . "
_ . " ..n:.:;... .:' ::.~ : ...
..~. .:.'-~:~~~;~{':" . , :; "~'" . .' . . . .,'; ......
. ~ ';":'-" ."
:.: -:....,..~. :f.-:: ~:.' . I'
.:.~ ~.I .::':_.". : ..,'. '..:. ..' ': \~: .:'" . .
". ':".~\" .:....~'. . ....
SinC01'oly yours,.
:e-fJ~~ &_ ttzJcGt-' ~~~.:
District uirector
. .
..... :" ".'...
. "
: "
.'. ~.
'. '. ........
."~ .
.. ,
, .::~ ~::...~.:..:., :::'.
I . .'
I
.-1,. .
.... ....
... '".:... :', ", .
.. '.' ..
." ," '. ~." :'..
.. .
.." ~.
.. . '.il:O;..
. :' :1'.. "...
. ...~
-',
"
" .
'. -;",'
", ~.
:-":
. . . ..
" .'..
. . ~ .:.
", .," :."....
..' . I,
._......... ...__..0.
. . : :.. .
"" ..
..':.:. .:--:..
.. ....
..'
,...'
~
.'
. .'~
...
..-
.. ~~ .
. -. .,
.-
'0
-'
~
.. ~ .
~
.~
. -"
"
~ .. ,
" ..
... .
.. "'....
. .. ~ .
.- .
.. ..... .
'.
, "
-
.o~... :.:
~
. ~ - .
-
... '.
.'
.. 0 '\ "",,-'"'
. .. ;~.
" ~;:" ":' ~" .~ :'~:~
---:-"-.-. ..-- -
.~..
.....
...-. .
.0 _.
\.
~
Form t.-179 (Re-r: 3-73)