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[null,"Please fill out this form and send it as an attachment to: info@annmariefoundation.org"]
[{"$nulls":8},"Send To"]
[{"$nulls":8},"  ANNMARIE FOUNDATION, INC."]
[{"$nulls":8},"  PO Box 44"]
[{"$nulls":8},"  Medford, WI 54451"]
[{"$nulls":8},"  Phone 651.303.2246"]
[{"$nulls":8}," info@annmariefoundation.org"]
["Application"]
["Date Submitted"]
["Organization Information"]
[null,"Name of Organization:"]
[null,"Address:"]
[null,"Organization's Tax Exempt Number:"]
[null,"What is the purpose of your orgainzation?"]
[null,"How many people are served by this activity?"]
[null,"What are your financial resources for the project?"]
[null,"How will this project impact the community?"]
["Request"]
[null,"Requested Item(s) (be specific & prioritize)",{"$nulls":5},"Intended Use",null,null,"Cost"]
[]
[]
[]
[]
[{"$nulls":7},"Total Amount Requested",null,null,{"$f":"SUM(K20:K23)","v":{"v":0,"d":"$0.00"}}]
[]
["Additional Information"]
[null,"List an information that may be helpful to the Board of Directors when they consider this request for funds:"]
[null,"(please limit to one attachment)"]
[]
[null,"Has this organization received an award from the ANNMARIE FOUNDATION? "]
[null,"If yes, date and amount of last grant"]
[null,"If no, please attach a copy of your tax exempt documentation."]
[null,"I agree to spend the funds awarded on the requested items and allow the ANNMARIE FOUNDATION to verify."]
[null,null,"Contact Person:",{"$nulls":5},"Phone:"]
[null,null,"Email:",{"$nulls":5},"Phone Ext.:"]
[null,"IF THIS IS ASCHOOL REQUEST, IT MUST BE APPROVED BY SUPERINTENDENT and sent in a prioritized packet from the Superintendent’s office."]
[null,"(Signature also required if school related request, i.e. booster club, PTA…)",{"$nulls":6},"     Print Name"]
[]
["Rev. 5/10/2017",{"$nulls":7},"     Signature"]

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