The recipient entity's physical address:
           19650 LA Highway 42
Livingston, LA 70754

The recipient entity's mailing address (if different):
           P.O. Box 392
Livingston, LA 70754

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:  5690

What is the dollar amount of the request?  $100,000

What type of request is this?  Capital Outlay Appropriation

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:
           Hulon Taylor, President
19310 Taylor Rd
Livingston, LA 70754

Charles McCon, Vice President
25365 S. Satsuma Rd
Livingston, LA 70754

Carlton Edwards, Secretary
P.O. Box 392
Livingston, LA 70754

Provide a summary of the project or program:
           Add an emergency generator to an existing water well site and purchase 2 pick-up trucks for operation and maintenance of the water system.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $100,000

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?
          Provide emergency back up for water service to customers and provide equipment to operate and maintain the water system as a whole.

What are the goals and objectives for achieving such purpose?
          The seek funding for the purchase of an emergency back up generator at an existing well site and to purchase pick-up trucks in order to maintain and operate the water system.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           3 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:
                
    
     (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:
                

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

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

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: 
               

(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:
              

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

          What is the nature of the relationship? 

(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:
                

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


Contact Information
name:  Carlton Edwards 
                                       address:  P.O. Box 392
Livingston, LA 70754
                                       phone:  225-698-3739
                                       fax: 
                                       e-mail:  colyellwater@eatel.net
                                       relationship to entity:  Secretary