Item 11.1 - Attachment 1 |
Attachment 1 - Fee Subsidy - Application Form |
APPLICATION
FOR FEE SUBSIDY FOR THE USE OF PUBLIC HALLS
AND COMMUNITY CENTRES - Annual Hirers 2009 - 2010 |
Date
Received: |
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Organisation Name: |
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Contact Name: |
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Contact Phone
Number: |
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Postal Address: |
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(Please
attach additional pages if there is insufficient room to provide all details) |
Yes |
No |
Does your
organisation have an ABN Number?
If Yes, please list details: |
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Is your
organisation registered for GST?
If Yes, please list details: |
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Is your
organisation based within the City of |
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Does your
organisation use the facility to provide social, community, cultural,
medical, artistic, educational or heritage benefit? Please list
details: |
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What income does
your organisation receive annually? |
Amount ($) |
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Membership Fees |
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Attendance Fees
(e.g. weekly contributions) |
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Donations |
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Sponsorship |
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Grants |
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Fundraising for
Organisation (inc. raffle income) |
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Fundraising for
Charity |
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Ticket Sales / Door
Takings |
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Other Income |
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TOTAL ANNUAL INCOME |
$ |
What expenditure
items does your organisation incur annually? |
Amount ($) |
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Instructors/Coaches/Other
Staff |
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Insurance |
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Administration
(Telephone, Postage, Stationery) |
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Affiliation/Association
Fees |
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Equipment
Hire/Purchase |
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Materials-Consumables
Hire/Purchase |
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Other Costs (Please
specify) |
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Facility Hire Costs |
Filled in by
Booking Office |
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TOTAL ANNUAL EXPENDITURE |
$ |
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Does your organisation
generate profit? If Yes, please list
details (including amount and destination of profit): |
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ANNUAL PROFIT = INCOME - EXPENDITURE |
$ |
(Please
attach additional pages if there is insufficient room to provide all details) |
Yes |
No |
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Does your
organisation hold a bank account? |
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Amount |
$ |
Date |
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If yes, is any of
this money committed to a specific purpose (other than annual operating
costs)? If yes, please
list details: |
Amount ($) |
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(Please
attach additional pages if there is insufficient room to provide all details) |
Yes |
No |
Is your
organisation able to meet the full cost of its activities? Please list
details: |
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If your
organisation did not receive a subsidy, would its operation remain viable? Please list details: |
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What level of
subsidy does your organisation request? |
$ |
Is there any other
information that you believe Council should know that might assist in
determining your organisation’s eligibility for a fee subsidy? |
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Please attach the
following documents (If not available, please indicate why) |
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Constitution |
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Registration as a
Charity |
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Most recent Annual
Report |
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Most recent Annual
General Meeting Minutes |
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Most recent
Financial Statement |
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Proof of
not-for-profit status |
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Please list any
other documents that you have provided to support your application. |
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I hereby certify that the information
provided in this application is true and correct. I undertake to advise I agree to state any financial
assistance provided by |
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Signature: |
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Date: |
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