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Contact Information <br />501(c)(3) Nonprofit Organization Contact Information <br />If you are applying with a fiscal sponsor, the information provided in this. section should correspond to the 501(c)(3) nonprofitorganization, as <br />they will be the legal grantee. <br />501(c)(3) Nonprofit Organization Name (As It Appears on IRS Forms)* <br />Action 4 Animals Hawaii <br />501(c)(3) Nonprofit Organization Mailing Address* <br />Street Address <br />P.O. Box 967 <br />Address Line 2 <br />City <br />State i Province / Region <br />Volcano <br />hi <br />Postal /Zip Code <br />Country <br />96785 <br />Hawaii <br />$01(c)(3) Nonprofit Organization Physical Address (if different from above) <br />Street Address <br />Address Line 2 <br />City State 1 Province! Region <br />Postal "ZIP Code <br />Country <br />501(c)(3) Nonprofit Organization Director <br />TitleSuffix <br />President <br />First Name. <br />Elaine <br />Last Name* <br />Partlow <br />Contact Person for Grant Correspondence <br />This person will be the primary point of contact for all communication related to this grant proposal and award. If the application is through a <br />501(c)(3) fiscal sponsor, provide the contact person for the projecUprogram. <br />Title *' <br />Treasurer <br />First Name* <br />Lucretia <br />Phone Number for Contact Person for Grant <br />Correspondence* <br />(206)351-5702 <br />Suffix <br />Last Name* <br />Worster <br />Email Address for Contact Person for Grant <br />Correspondence* <br />lucretia@a4ehawaii.com <br />8. Are you serving as a 501(c)(3) fiscal sponsor for this application?* <br />0 Yes ' ; No <br />Action 4 Animals Hawaii - Fixed, Chipped, and Healthy Pets for Hawaii <br />