Required fields are marked with asterisks (*)

Cemetery Improvement Grant Application

Please ensure that you provide full, complete and clear answers to the questions on this form. Failure to provide the required information may result in your organization being ineligible. Missing or unclear information may result in the application being delayed or rejected.

Name of Community Organization

Name of Contact Person

Contact Phone Number

Contact Email Address

Mailing Address of Contact Person

Website (if applicable)

As part of the required screening process, the Township of South Stormont would like to know what funds are available to the associated Cemetery and if there is a Care and Maintenance Fund established. This information will not be shared to any third-party and used only to ensure that the grant money is used for Cemeteries in need of funding.

If funds are available, please indicate the amount.

Purpose of Grant

Amount of Grant Requested (maximum $5,000)

Has this cemetery received any money from the Township in previous years?

Yes

I declare that I am an authorized offical acting for the cemetery indicated in the application.

I am an authorized official acting for the cemetery

The release of all funds is contingent upon the Township of South Stormont receiving a copy of your financial statements for the previous year. I f your financial statements do not clerarly identify a need for the funding request, applications will be denied.