Form MO780-2165 "District Grant Application and Funding Request Form" - Missouri

What Is Form MO780-2165?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on March 1, 2012;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-2165 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-2165 "District Grant Application and Funding Request Form" - Missouri

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STATE OF MISSOURI
MISSOURI DEPARTMENT OF NATURAL RESOURCES
SOLID WASTE MANAGEMENT PROGRAM
DISTRICT GRANT APPLICATION AND FUNDING REQUEST FORM
REGION IDENTIFICATION (A-T):
DISTRICT CHAIRPERSON’S NAME:
PAGE
OF
DISTRICT NAME:
NUMBER OF PROJECTS THIS SUBMISSION:
DISTRICT’S FEDERAL ID
FISCAL YEAR :
1
2
3
4
5
6
7
8
PROJECT
DO, PI or
TOTAL
DISTRICT
INTEREST
PROGRAM
DNR
AREA
NUMBER
CC
PROJECT
CARRYOVER
INCOME
INCOME
REMITTABLE
SERVED
AWARD
(At District)
(At District)
(At District/
ALLOCATION
Subgrantee)
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL
$0.00
$0.00
$0.00
$0.00
$0.00
9 CUMULATIVE YEAR TO DATE DO AND PI
EXECUTIVE BOARD CERTIFICATION
I hereby certify that the district executive board has evaluated and ranked applications according to established state and
district requirements (attach aggregate ranking). I hereby certify that the information provided in the application(s) is true
and correct and conforms to all state and department of natural resources, solid waste management program requirements.
DISTRICT CHAIRPERSON SIGNATURE
DATE
MO 780-2165 (03-12)
STATE OF MISSOURI
MISSOURI DEPARTMENT OF NATURAL RESOURCES
SOLID WASTE MANAGEMENT PROGRAM
DISTRICT GRANT APPLICATION AND FUNDING REQUEST FORM
REGION IDENTIFICATION (A-T):
DISTRICT CHAIRPERSON’S NAME:
PAGE
OF
DISTRICT NAME:
NUMBER OF PROJECTS THIS SUBMISSION:
DISTRICT’S FEDERAL ID
FISCAL YEAR :
1
2
3
4
5
6
7
8
PROJECT
DO, PI or
TOTAL
DISTRICT
INTEREST
PROGRAM
DNR
AREA
NUMBER
CC
PROJECT
CARRYOVER
INCOME
INCOME
REMITTABLE
SERVED
AWARD
(At District)
(At District)
(At District/
ALLOCATION
Subgrantee)
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL
$0.00
$0.00
$0.00
$0.00
$0.00
9 CUMULATIVE YEAR TO DATE DO AND PI
EXECUTIVE BOARD CERTIFICATION
I hereby certify that the district executive board has evaluated and ranked applications according to established state and
district requirements (attach aggregate ranking). I hereby certify that the information provided in the application(s) is true
and correct and conforms to all state and department of natural resources, solid waste management program requirements.
DISTRICT CHAIRPERSON SIGNATURE
DATE
MO 780-2165 (03-12)