The recipient entity's physical address:
           1004 NOLAN ST.
DONALSONVILLE, LA. 70346

The recipient entity's mailing address (if different):
           P.O. BOX 1609
DONALSONVILLE, LA. 70346

Type of Entity (for instance, a nonprofit corporation):  Non-Profit Corporation

If the entity is a corporation, list the names of the incorporators:
          

The last four digits of the entity's taxpayer ID number:  4613

What is the dollar amount of the request?  $225,000

What type of request is this?  Both

Is this entity in good standing with the Secretary of State?  Yes

Provide the name of each member of the recipient entity's governing board and officers:
           DARRYL OVIDE 120 GREENBRIAR ST BELLEROSE.LA 70341 PRESIDENT
DELETRIECK DICKERSON 39250 SUPERIOR WOOD AVE GONZALES LA.70737 VP
HERBERT EDWARDS 10525 BOUDREAUX RD. GONZALES LA.70737 SEC.
STEVEN JOSEPH 139 EVANGELINE DONALDSONVILLE LA.70346 TRE.

Provide a summary of the project or program:
           To finish remolding the building to service the community more efficiently.
1. Demolish the interior and reconfigure the space
2.Upgrade electrical and plumbing
3.Upgrade HVAC
4.Install new flooring
5.repair and upgrade restrooms for handicap access
6.Replace doors and windows
7.Install shower
8.Install standby generator
9 Pour concrete for food pantry install wall and windows etc.
10Cover outer area with stucco

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $225,000
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $0

Does your organization have any outstanding audit issues or findings?  No

If 'Yes' is your organization working with the appropriate governmental agencies to resolve those issues or findings?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          Hiram lodge #12 has been a part of the community for over 100 years, providing education, mentorship and leadership for the community, with the upgrades and additions we can continue to provide and create more way to be of service for the community

What are the goals and objectives for achieving such purpose?
          1.Continue to provide education, leadership and mentorship
2.Open food pantry to service the community
3.Provide safe area during different natural disasters like hurricane and floods

What is the proposed length of time estimated by the entity to accomplish the purpose?
           18 months

If any elected or appointed state official or an immediate family member of such an official is an officer, director, trustee, or employee of the recipient entity who receives compensation or holds any ownership interest therein:
     (a) If an elected or appointed state official, the name and address of the official and the office held by such person:
                 N/A
    
     (b) If an immediate family member of an elected or appointed state official, the name and address of such person; the name, address, and office of the official to whom the person is related; and the nature of the relationship:
                 N/A

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 N/A

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                  N/A

If the recipient entity has a contract with any elected or appointed state official or an immediate family member of such an official or with the state or any political subdivision of the state:
(a) If the contract is with an elected or appointed state official, provide the name and address of the official and the office held by such person: 
               N/A

(b) If the contract is with an immediate family member of an elected or appointed state official:
          Provide the name and address of such person:
               N/A

          Provide the name, address, and office of the official to whom the person is related:
                N/A

          What is the nature of the relationship?  N/A

(c) If the contract is with the state or a political subdivision of the state, provide the name and address of the state entity or political subdivision of the state:
                 N/A

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               N/A


Contact Information
name:  Deletrick Dickerson 
                                       address:  39250 Superior Wood Ave GONZALES LA.70737
                                       phone:  2253169267
                                       fax: 
                                       e-mail:  dickerson6922@gmail.com
                                       relationship to entity:  VICE PRESIDENT