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(Certified Current 5110/07) <br /> APPLICATION FOR 2. DATE SUBMITTED Applicant Identifier <br /> FEDERAL ASSISTANCE 4/29/2009 <br /> 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier <br /> Application Preapplication 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> Construction ❑ Construction 3-05-0004-009-2009 <br /> Non-Construction ❑ Non-Construction <br /> -Jr APPLICANT INFORMATION <br /> Legal Name: Organizational Unit: <br /> City of Batesville Department: Airport Commission <br /> Organizational DUNS: 075 627 468 Division: <br /> Address: Name and telephone number of person to be contacted on <br /> Street: 500 East Main matters involving this application(give area code) <br /> Prefix: Mrs. First Name: Mary <br /> City: Batesville Middle Name: <br /> County: Independence Last Name: Amos <br /> State: Arkansas Zip Code: 72501 Suffix: <br /> Country: United States Email: <br /> 6.EMPLOYER IDENTIFICATION NUMBER Elly: Phone number(give area code): FAX number(give area code): <br /> 7 1 - 0 5 1 2 4 0 3 870-251-1244 870-251-3379 <br /> 8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) <br /> ® New ❑ Continuation ❑ Revision <br /> Other(specify) Municipal <br /> If Revision,enter appropriate letter(s)in box(es): — <br /> (See back of form for description of letters) ❑ 9. NAME OF FEDERAL AGENCY <br /> Federal Aviation Administration <br /> Other(specify) <br /> 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER Seal and Remark R/W 8-26 & Parallel Taxi:":ay: <br /> 2 0 - 1 0 6 <br /> TITLE: Airport Improvement Program <br /> 12. AREAS AFFECTED BY PROJECT(cities,counties,states,etc.): <br /> Batesville, Indepence County, AR <br /> 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF <br /> Start Date Ending Date a. Applicant b. Project <br /> May 09 May 10 1st I 1st <br /> 15.ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE <br /> EXECUTIVE ORDER 12372 PROCESS <br /> a. Federal $ 196905 a.Yes. ® THIS PREAPPLICATION/APPLICATION WAS MADE <br /> AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 <br /> b. Applicant $ 10363 PROCESS FOR REVIEW ON <br /> c. State $ uu DATE: 4/30/2009 <br /> d. Local $ Uu b.No. ❑ PROGRAM IS NOT COVERED BY E.O.12372 <br /> e. Other $ ❑ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR <br /> REVIEW <br /> f. gram income $ uu <br /> 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> 9 $ 207268 ❑Yes If"Yes"attach an explanation ® No <br /> 1` ;EST OF MY KNOWLEDGE AND BELIEF,ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT,THE <br /> D:CUMENI HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br /> ;-17AC€ED ASSURANCES IF THE ASSISTANCE IS AWARDED. <br /> a. Authorized Representative <br /> Prefix First Name Rick Middle Name <br /> Last Name Eiumbau h Suffix <br /> b.Title Mayor c.Telephone number(give area code) <br /> 870-698-2400 <br /> C natu o1 thod d Representative e.Date Signed = lIF �- <br /> Previous Editions NbMsable Standard Form 424 (Rev.9-2003) <br /> Authorized for Local Reproduction Prescribed by OMB Circular A-102 <br />