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Local Government Limited Gaming Impact Fund Application - Colorado Department Of Local Affairs

Rev.1/99

For Use by State

STATE OF COLORADO

Department of Local Affairs

LOCAL GOVERNMENT LIMITED GAMING IMPACT FUND APPLICATION

Planning, Construction and Maintenance of Public Facilities,

and Provision of Public Services Related to Gaming Impacts

A. GENERAL AND SUMMARY INFORMATION

1. Name/Title of Project:

2. Applicant:

3. Chief Elected Official

Name:

Title:

Mailing Address:

Phone:

4. Designated Contact person for the Application:

Name:

Title:

Mailing Address:

Phone:

5. Brief Description of Project

(100 words or less)

If this is a construction project, attach a map showing the location of the project.

6. Local Priority if available. (Relative to other applications within the county, e.g. 1 of 2, 2 of 4, etc.) ______________

Note: Local prioritization is strongly encouraged by the Local Government Gaming Impact Advisory Committee. However, a priority

ranking of projects is not required to be reviewed favorably and awarded funds. Be aware that the committee will consider other factors

in addition to local ranking to make its final advisory funding decision.

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Local Government Limited Gaming Impact Fund Application - Colorado Department Of Local Affairs