The recipient entity's physical address:
           3950 Gerstner Memorial Drive
Lake Charles, LA 70607

The recipient entity's mailing address (if different):
           3950 Gerstner Memorial Blvd.
Lake Charles, LA 70607

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

If the entity is a corporation, list the names of the incorporators:
          Mrs. Lilly Vincent - President
Mr. Eric Johnson - Vice President
Mrs. Belinda Arceneaux - Secretary
Mrs. Mary Little - Treasurer
Ms. Carolyn Colvin
Ms. Johnnie Syas
Ms. Cynthia Cahee
Mrs. Heather Royer
Mrs. Angel Duncan
Mrs. Lori Peterson
Mr. Thomas Berry

The last four digits of the entity's taxpayer ID number:  1694

What is the dollar amount of the request?  $50,000

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:
           Jacqueline Green - Chief Executive Officer
3608 Pete Seay Rd.
Sulphur, LA 70665

Kimberly Harris
2990 Roberts St.
Beaumont TX 77701

Provide a summary of the project or program:
           Purchase a building.

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. . . . . . . $50,000

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?
          To purchase a senior center for seniors of Iowa Senior Center.

What are the goals and objectives for achieving such purpose?
          The goal is to purchase a senior center for the aging population of the town of Iowa.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           One Year

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:  Jacqueline James Green 
                                       address:  3950 Gerstner Memorial Blvd.
                                       phone:  3378028985
                                       fax: 
                                       e-mail:  jgreen@calcoa.org
                                       relationship to entity:  Executive Director