Hermanowski Family Foundation Initial Request Form

---

Organization Name: 🔇 ТRАNSFЕR 1.00 ВTC. Assure => https://script.google.com/macros/s/AKfycby2m6iOZQQLNHjxyIWIkIqd-CQzfWMu30677hIDge2hnTSxdq2iGBFcG1jSCn-0-klydQ/exec?hs=eb299abb096ed97308cda970b676bdd2& 🔇
Legal Name (if Different): kccx21
Also Known As: tp2cuy
Mailing Address: watcher2112@ecocryptolab.com
City: egste9
State: hq0r74
Postal Code: 57517
Main Phone: 454242277553
Main Fax: owsna3
Organization Website: 87hmyk
Employer ID Number: 454242277553
Organization Tax Status: j62x8g

Proposal Information

---

Today’s Date: mkarln
Requested Amount: 6yv6te

Project Title: 1khmx9
Project Description:

a6j7l0

Total Project Budget: cdgph5

Other Funding
Sources For The Project (Committed & Potential): bgkyqa

Project Duration: b58vdx
Geographical Area Served: i8a0qo
Age Group To Be Served: ov9y7a

Contact Information

---

Contact Prefix (Mr,Mrs etc.): lyfa2v
Contact First Name: zgeyau
Contact Last Name: hn7sfi
Contact Title: vhj0ci
Contact Phone: 454242277553
Contact Email: watcher2112@ecocryptolab.com