Monticello Opera House DCA Grant Proposal

Transcription

1 Monticello Opera House DCA Grant Proposal 1. LAA County Designation Letter 2. LAA City Designation Letter 3. Substitute W-9 4. Non-profit Status Documentation

2 BOARD OF COUNTYCOMMISSIONERS JEFFERSON COUNTY, FLORIDA THE KEYSTONE COUNTY-ESTABLISHED WEST WALNUT STREET; MONTICELLO, FLORIDA PHONE: (850) Benjamin Bishop Gene Hall Hines F. Boyd Betsy Barfield Stephen Walker District 1 District 2 Vice-Chair District 3 District 4 District 5 Chairman June 1, 2016 Florida Department of State, Division of Cultural Affairs - Florida Council on Arts and Culture R.A. Gray Building 500 South Bronough Street Tallahassee, Florida Dear Florida Council on Arts and Culture: As a member of the Jefferson County Board of County Commissioners it is my pleasure to support the Monticello Opera House in their efforts to secure a General Program Support Local Arts Agency Grant from the Florida Department of State Division of Cultural Affairs. The Monticello Opera House provides services, support, and programs for arts organizations, artists, and the local community. Added to the support for the Arts, the Monticello Opera House provides workshops covering many opportunities including but not limited to: advertising, networking, and professional development. Periodic publications, both and print, with events and opportunities for individuals and organizations regarding arts and culture are provided allowing the Opera House to further focus on stimulating the local economy through the arts, aiming to make the arts and cultural offerings of the region accessible to visitors and citizens. Our County Commissioners recognize the importance of culture and the arts in improving the quality of life for our citizens through a vibrant creative arts industry that supports tourism and the local economy. Jefferson County has a long history of supporting arts programming which we continue as our cultural legacy. In order to further this support for a collaborative arts and cultural industry, the Jefferson County Commission recognizes the Monticello Opera House, Inc. as the official Local Arts Agency (LAA). The Monticello Opera House Inc. is the principal cultural arts and performance center for our county and acts to strengthen broad partnerships in arts programming that stimulates and advances the creative economy, embraces diversity and enhances the well-being of all of our citizens. Jefferson County is aware that artists are a great cultural asset worth our support at the same time working to preserve the Perkins Block Opera House, our unique architectural gem. Thank you for your consideration, Gene Hall Gene Hall, Vice-Chairman Kirk Reams Parrish Barwick T. Buckingham Bird Clerk of Courts County Coordinator County Attorney

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4 State of Florida Chief Financial Officer Department of Financial Services Bureau of Accounting 200 East Gaines Street Tallahassee, FL Telephone: (850) Fax:(850) Substitute Form W-9 In order to comply with Internal Revenue Service (IRS) regulations, we require Taxpayer Identification information that will be used to determine whether you will receive a Form 1099 for payment(s) made to you by an agency of the State of Florida, and whether payments are subject to Federal withholding. The information provided below must match the information that you provide to the IRS for income tax reporting. Federal law requires the State of Florida to take backup withholding from certain future payments if you fail to provide the information requested. Taxpayer Identification Number (FEIN): IRS Name: MONTICELLO OPERA HOUSE INC Address: PO BOX 518 MONTICELLO, FL Attention Of: JAVIER BETANCOURT Business Designation: Not For Profit Certification Statement: Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer information AND 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding AND 3. I am a U.S. citizen or other U.S. person (including U.S. resident alien) Preparer's Name: JAVIER BETANCOURT Preparer's Title: EXECUTIVE DIRECTOR Phone: monticellooperahouse@gmail.com Date Submitted: 08/28/2015 Date printed from the State of Florida Substitute Form W-9 Website: 05/04/2016

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