The recipient entity's physical address:
           238 Bowie Road
Raceland, LA 70394

The recipient entity's mailing address (if different):
           P O Box 500 Raceland, LA 70394

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

If the entity is a corporation, list the names of the incorporators:
          Allen Rebstock, Chairman
MAudrey Vizier, Vice Chairman
Carla Landry, Secretary/Treasurer

The last four digits of the entity's taxpayer ID number:  6130

What is the dollar amount of the request?  $175,000

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:
           Charlene Rodriguez, Executive Director 103 Myrtle Delaune Street Lockport, LA 70374
Allen Rebstock, Chairman 142West 109th Street Cut Off, LA 70345
Maudrey Vizier, Vice Chairman,203 East 28th Street Cut Off, La 70345
Carla Landry Secretarry/Treasurer 210 Pelican Drive Raceland, LA 70394
Andrew Robertson Board Member 202 Winder Road Thibodaux, La 70394
Virginia Ordoyne Board Member 979 Hwy 20 Thibodaux, LA 70301
Eddie Landeche Board Member 3336 Hwy. 1 Raceland, LA 70394
Annette Adams Board Member 534Hspital Drive Raceland, LA 70394
Shaheedah RA-Oof Board Member 475 Fredrick Drive Thibodaux, LA 70301
Phillip Gouaux III Board Member 1421 Hyland Drive Lockport, LA 70374
Daniel Pellegrin Board Member 162 Easst 123rd Street Galliano, LA 70357
Dianna Toups Board Member 2013 North Bayou Drive Golden Meadow, LA 70357
Patricia Adams Board Member 318 Church Streeet Lockport, LA 70374
Stephen Baudoin Board Member 209 Justin Street Lockport, LA 70374

Provide a summary of the project or program:
           The Lafourche Council on Aging, Inc. is in the process of building a new office. After Hurricane Ida, we were asked to relocate the building we were in. Since then, we decided to build our own building. This project would assist the Lafourche Council on Aging with the extra funding we need to complete the new office along with the furnishings.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $90,000
          Major Repairs . . . . . . . $0
          Operating Services. . . . $50,000
          Other Charges. . . . . . . $35,000

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?
          Not Applicable

What is the entity's public purpose, sought to be achieved through the use of state monies?
          The purpose is to be able to have our own building in order to provide services to seniors 60 years of age and older to keep them as independent as possible in their own homes. With purchasing a generator for this new building and furnishings. we would be able to stay opened if roads are passable when the electricity goes out. We would be able to continue providing the services that are much needed to the clients. During hurricane season it would also assist when we have to do payroll. Last hurricane, we had to go to the bank in order to do payroll.

What are the goals and objectives for achieving such purpose?
          Our goal is to be able to have an office to be able to call our own.
Objective is to continue to provide services to the seniors who are home bound and in need of our services.

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:  Charlene Rodriguez 
                                       address:  238 Bowie Road
P O Box 500
                                       phone:  9855320457
                                       fax:  none
                                       e-mail:  lafcoadirector@viscom.net
                                       relationship to entity:  Executive Director