State Form 54223 "Grant Application" - Indiana

What Is State Form 54223?

This is a legal form that was released by the Indiana Archives and Records Administration - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2012;
  • The latest edition provided by the Indiana Archives and Records Administration;
  • 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 State Form 54223 by clicking the link below or browse more documents and templates provided by the Indiana Archives and Records Administration.

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Download State Form 54223 "Grant Application" - Indiana

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INDIANA STATE HISTORIC RECORDS ADVISORY BOARD
GRANT APPLICATION
402 West Washington Street, Room W472
Indianapolis, IN 46204
State Form 54223 (R3 / 8-12)
Telephone: (317) 232-3380
Fax: (317) 233-1713
E-mail: shrab@icpr.in.gov
Website: shrab.IN.gov
Please complete this form, the Proposed Budget (State Form 54237), and a narrative.
Type of application (check one)
Date of application (month, day, year)
Employer identification number (EIN)
New
Revision
Legal name of applicant
DUNS number
Department
Division
Type of organization
Address (number and street, city, state, and, ZIP code)
Name of contact person
Title of contact person
E-mail address
Telephone number
Fax number
(
)
(
)
Descriptive title of applicant’s project
Beginning date of proposed project (month, day, year)
Ending date of proposed project (month, day, year)
Annual budget
Staff size
ESTIMATED FUNDING
Indiana State Historic Records Advisory Board (SHRAB)
$
Applicant
$
Local
$
Other (Please specify)
$
TOTAL
$
AFFIRMATION
I hereby affirm that all data in this application are true and correct to the best of my knowledge and belief. This document has been duly authorized by the
governing body of the applicant. If the Board awards assistance, the applicant will comply with the attached assurances and all requirements, express
or implied, contained in “Grant Guidelines”, “Grant Budget”, and “Grant Terms and Conditions”. Non-compliance with any requirement contained within
this or any of the aforementioned documents may result in revocation of funds granted and of all related obligations, subject to the discretion of the
Indiana State Historic Records Advisory Board (SHRAB).
Signature of authorized representative
Date of signature (month, day, year)
Printed name of authorized representative
Title of authorized representative
E-mail address
Telephone number
(
)
Reset Form
INDIANA STATE HISTORIC RECORDS ADVISORY BOARD
GRANT APPLICATION
402 West Washington Street, Room W472
Indianapolis, IN 46204
State Form 54223 (R3 / 8-12)
Telephone: (317) 232-3380
Fax: (317) 233-1713
E-mail: shrab@icpr.in.gov
Website: shrab.IN.gov
Please complete this form, the Proposed Budget (State Form 54237), and a narrative.
Type of application (check one)
Date of application (month, day, year)
Employer identification number (EIN)
New
Revision
Legal name of applicant
DUNS number
Department
Division
Type of organization
Address (number and street, city, state, and, ZIP code)
Name of contact person
Title of contact person
E-mail address
Telephone number
Fax number
(
)
(
)
Descriptive title of applicant’s project
Beginning date of proposed project (month, day, year)
Ending date of proposed project (month, day, year)
Annual budget
Staff size
ESTIMATED FUNDING
Indiana State Historic Records Advisory Board (SHRAB)
$
Applicant
$
Local
$
Other (Please specify)
$
TOTAL
$
AFFIRMATION
I hereby affirm that all data in this application are true and correct to the best of my knowledge and belief. This document has been duly authorized by the
governing body of the applicant. If the Board awards assistance, the applicant will comply with the attached assurances and all requirements, express
or implied, contained in “Grant Guidelines”, “Grant Budget”, and “Grant Terms and Conditions”. Non-compliance with any requirement contained within
this or any of the aforementioned documents may result in revocation of funds granted and of all related obligations, subject to the discretion of the
Indiana State Historic Records Advisory Board (SHRAB).
Signature of authorized representative
Date of signature (month, day, year)
Printed name of authorized representative
Title of authorized representative
E-mail address
Telephone number
(
)