Okaloosa County BOCC — October 6, 2015 — LETF Request — reading text

approved and in conformity with Florida law. I further agree that should I fail to provide such documentation within the specified time period, I will be responsible for reimbursing Okaloosa County for the amounts received. for Law Enforcement Trust Fund and applicable state statutes. I have completed this application o “fully and accurately and have not misrepresented any information contained herein.” I certify that =~ |~ - q \ w\ b Signatur ppligdnt Daté of Application TeAd T Ldhicy Print Name of Applicant OFFICIAL USE ONLY I, Larry R. Ashley, do hereby certify that the aforementioned request for LETF proceeds is in compliance with S;ctiym%, ida S tutes. Sheriff Lafty R. Ashli// Board of County Commissioners: Approved/Disapproved Date: Amount approved: $ " OKALOOSA COUNTY LETF APPLICATION " PROGRAM INFORMATION | Program Title: Name/ Titie of Contact: Dr. Martin Luther King Celebration Committee of Okaloosa County Justin Lee, Chair iloAddresss e PO CBoX-4331 - Phone:... ... .1 (301) 906-1229 | City * Zip Code: Ft. Walton Beach, 32548 Fax: ’f Total Program Budget: |$0 E-mail: justin.lee.17@us.af.mil Program is: New Renewal Amount D Requested: : $2000 If renewal, circle number of years this program has been funded thru LETF? 1 Year — APPLICANT AGENCY INFORMATION Applicant Agency Legal Name: Dr, Martin Luther King Celebration Committee of Okaloosa County Program Name: Dr. Martin Luther King Celebration Committee of Okaloosa County Main Administrative Address: P.QO. Box 4331 City & State: Ft, Walton Beach, FL Zip Code: 32548 Telephone Number: (301) 906-1229 Fax Number: Website: www.drmlkjrcelebration.com CEO/Executive Director: Justin Lee Office Phone Number: (850) 883-2708 E-mail Address: justin.lee.17 @us.af.mil Federal Identification Number: N/A LETF CATEGORY (Place an “X” to the left of one program area for which you Intend to Apply): 1. Crime Prevention 2. Drug Abuse Prevention/Education 3. Safe Neighborhood 4. School Resource Officer RSN 5. Other Law Enforcement Purpose (specify below) PROPOSED PROGRAM INFORMATION 1. Program Summary (1-3 sentences): Provide an overview of program services. ‘| The Dr. MLK Celebration Committee was created in an effort to sponsor educational opportunities; promote cultural awareness, and revitalize the communities of Northwest Florida immediately North, | South, East, and West of Okaloosa County; thereby, improving the quality of life for famlltes students, | ‘land youth living within the cities of its surrounding neighborhoods. 2. Program Purpose (1-3 sentences): Please identify the services, target population and how many will be served while completing the following statement. The purpose of this program is... To effect change in our community by celebrating diversity within Okaloosa County and neighboring areas. Our target population of 60,000 will be engaged in thought provoking, speaker led discussions and motivational assemblies in addition to being challenged through guided attistic expression. 3. Proposed use of LETF proceeds: Please identify the proposed use(s) of LETF proceeds and specify how it fulfills the statutorily authorized uses set forth in Section 932.7055, Florida Statutes. These proceeds shall not be utilized to meet normal operating needs of the applicant agency/organization. These funds would be used to promote Drug Abuse Prevention/Education by obtaining literature that would be disseminated amongst the community for free, hiring influential speakers in the community to discuss the importance, and promoting healthy living during the Oratorical/Poster Contest, Memorial Program, and After-Rally Activities. The funding would be used to bridge awareness and education to improve the quality of living for the Okaloosa County Community. We have a number of dates scheduled for our events which include the following: 4. Has your agency received funding from LETF within the last three (3) years? (If yes, identify the source of that funding, when it was received and the dollar amount that the agency has received). The Committee has received funding from LETF within the last three years, November 2014. The funding amount was $1,000 that assisted with applying and receiving Section 501(c)(3) of the Internal Revenue Code and applicable state law (s) for tax exempt grants that will help fund Community Outreach Activities, Educational Initiatives including Crime Prevention, and Revitalization of Low Income Neighborhoods throughout the year. 5. Have you applied for funding for this program from any other entity or agency? (If yes, identify the source from which the funding was sought, the dollar amount requested from the source and provide the outcome of that application). Yes, | have applied for and received funding in the amount of $1,000 to support the acquisition of Section 501(c)3) of the internal Revenue Code and applicable state law(s) for tax exempt grants, and received approval. ~~Upon completing this application in its entirety, please read the following statement and affix your signature accordingly. T have read, fully understand and agree to'be bound by Okaloosa County’s Operating Procedures | === for Law Enforcement Trust Fund and applicable state statutes. I have completed this application *"'Afully and accurately and have not misrepresented any information containéd herein. I'certify that— " “the requested funds will be used for the purposes set forth in this application and in conformity with Florida law. I agree to submit proper supporting documentation within ninety (90) days of expending the LETF proceeds, which establishes that such proceeds were expended for the purposes they were approved and in conformity with Florida law. I further agree that should I fail to provide such documentation within the specified time period, I will be responsible for reimbursing Okaloosa County for the amounts received. Dighaly signed by LEEJUSTIN G 1367421608 LEE.JUSTIN.C.1367431 60§ ",ou,—f'JSAF.'Sr;:teé.Jfigmfi:fibfita:fid;um ) 1 8 Au g Ust 20 1 5 Date: 2015.08.18 16:16:26 -05'00° Signature of Applicant Date of Application Justin Lee Print Name of Applicant OFFICIAL USE ONLY I, Larry R. Ashley, do hereby certify that the aforementioned request for LETF proceeds is in compliance with Section 932.70535, Florida Statutes. Sheriff Larry R/Ashley / Board of County Commissioners: Approved/Disapproved Date: Amount approved: $