Phone: 1-902-226-2400

Toll Free: 1-800-567-2600

Municipal District Infrastructure Form Application

Municipality of Richmond County Application for Assistance "Municipal District Infrastructure Fund"

Instructions

*Applicants must complete application form in its entirety and provide appropriate attachments. We accept .doc, .docx and .pdf file formats. Include attachments when not provided adequate space.

*Submit the completed and signed original application form along with attachments to P.O. Box 120, Arichat, Nova Scotia, B0E 1A0

Attention: Grant Requests
*Please keep a complete copy for your own records *It is advisable to inform the district councillor of the application as funds are allocated by district and must be approved by Council.

Complete online form or download Municipal District Infrastructure Fund Policy

Identification Of Applicant

Upload evidence of legal name & status.(*)
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Address & Postal Code:(*)
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Project Location:(*)
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Name of Applicant:(*)
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Position:(*)
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Telephone Number:(*)
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Email:
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Form of Organization(*)

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Explain the purpose of your organization:
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Documents to Upload

-Attach a photocopy of current Registry of Joint Stocks renewal & file number -Attach a list of names and addresses of current Board of Directors and Officers -Attach financial statements for the last fiscal year -Attach budget for current fiscal year
Upload Photocopy of current Registry of Joint Stocks renewal & file number.
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Upload list of names and addresses of current Board of Directors and Officers.
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Upload consolidated Financial statements for the last fiscal year.
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Upload budget for current fiscal year.
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History of past successful projects completed by your organization:(*)
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Identification Of Project Or Activity

Describe the project or activity, to include information on the overall benefit to the community, and the amount of community involvement.(*)
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Provide a work plan that includes starting and ending dates, number of employees and total work weeks involved.(*)
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Have you applied for financial assistance from other levels of government or funding agencies? Please explain(*)
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Does your organization receive a HST Rebate?(*)
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Cost of Project

Capital Costs

Land
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Land Improvements
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Materials
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Labour Costs
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Other Capital Costs
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Specify
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Other Capital Costs
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Specify
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Total:(*)
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Financing Of Project

Stakeholder Equity
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Stakeholder Loan
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Funding Agency
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Provincial
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Federal
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Municipality of Richmond
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Other: Specify
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Other: Sepcify
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Total:(*)
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Applicant must provide source of funds for Stakeholder Equity and Stakeholder Loan
Date:(*)

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Name & Position of Individual Signing(*)
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By checking this box, I agree that the information submitted is accurate.(*)

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Security:(*)
Security:
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