Local Government Limited Gaming Impact Fund Application - Colorado Department Of Local Affairs Page 2

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B. BUDGET & INFORMATION
1. Project Budget & Funding Sources
Project Funding
Other Funds Requested or
Committed
State Gaming
PROJECT ACTIVITIES LIST
Total Cost
Amount
Source
Status*
Share
*e.g. committed, in application stage, etc.
2. Applicant’ s Financial Information
If applicable, provide for all counties, municipalities and special districts participating in the application. Attach additional
sheets if necessary.
Entity Name
Entity Name***
Entity Name***
a. Assessed Valuation (Year
)
$
$
b. Mill Levy
c. Overlapping Mill Levy*
d. Sales Tax Rate (%) / Annual Revenue
%
%
%
e. Long-Term Debt, by Type/Amount
/
/
/
f. Annual Budget** (
Fund)
Total (Year
)
Carry Forward (as of 1/1/
)
--------------------------------------
* Sum of mill levies of overlapping jurisdictions (e.g. sum of levies of municipality, school district, etc.)
** For fund most relevant to application (e.g. General Fund for housing applications, Sewer Fund for sewer applications, etc.)
*** Use only in case of multi-jurisdictional or on-behalf-of applications to provide the requested information for other directly participating entities.
Page 2 of 8 Pages

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