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i <br /> 7/9/08 <br /> COUNTY OF HA AI`I <br /> CONTINGENCY RELIEF FUNDS REQUEST <br /> TO: .Parks &Recreation DATE: 03122123 <br /> Department <br /> FROM: Ashley Kierkiewicz PHONE/FAX: (808) 961-8265 <br /> Council Member <br /> A. REQUEST(ATTACH BACKUP INFORMATION,IF AVAILABLE) <br /> 1. AMOUNT: $1500 2. To ACCOUNT##(i.e., 010.500.55(13.02): 010.500.5503.02 <br /> 3. To ACCOUNT NAME (Le.,P&R Admin. OCE): P&R Admin OCE 115 Misc. Contract Services <br /> 4. PURPOSE(S)OF TRANSFER: To support community bereavement event, the 19th Annual Celebration of <br /> Le in Hilo, HI that will raise funds for free, community grief support and counseling programs <br /> 5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION,NAME OF ORGANIZATION: <br /> 6. IS IT A 501(C)(3)? M YES ❑ No <br /> *If YES,the IRS determination letter and the Nonprofit Conflict <br /> Hospice of Hilo DBA Hawaii Care Choices Disclosure Form must be attached to this request form. <br /> 7. COUNTY-RELATED PROGRAM(S)OR ACTIVITY(IES)TO BE FUNDED: Family Visitation Center <br /> 8. DEPARTMENTAL GOALS AND OBJECTIVES TO BE ADDRESSED: To increase access and programs for <br /> East Hawai`i community's mental and emotional well-being <br /> 9. FUNDING TO BENEFIT THE PUBLIC-AT-LARGE(AS OPPOSED TO PRIVATE BENEFIT)? ®YES ❑ NO <br /> 10. IS THE PROGRAM OR ACTIVITY FUNDED ESTABLISHED BY CHARTER,ORDINANCE,OR DIRECTION <br /> OF THE MAYOR? ❑YES ®NO <br /> B. DEPARTMENT'S RECOMMENDATION: <br /> ®APPROVE ❑DENY ❑DEFER: <br /> RATIONALE: <br /> DATE: <br /> s epartment Head <br /> C. M OR'S ACTION <br /> APPROVED ❑DENIED ❑DEFERRED: <br /> COMMENTS: <br /> DATE: az <br /> }Mayor <br />