ARKANSAS DEPARTMENT OF PARKS AND TOURISM

TOURISM ATTRACTION FEASIBILITY STUDY PROGRAM

MATCHING FUND APPLICATION

REQUEST FOR PAYMENT

Applicant(s): ____________________________________________________________

Project Title: ____________________________________________________________

Agent’s Name: __________________________________________________________

City/State/Zip: _________________________________________________________

Phone Number: __________________________________________________________

Fax Number: ____________________________________________________________

E-Mail: _________________________________________________________________

County: ________________________________________________________________

The above city/county hereby makes application for a matching fund grant under the provisions of Act 728 of 1999 for the following tourism attraction feasibility study:

Project Title Total Project Cost Matching Share Claimed

_______________________________ __________________ _____________________

This is to CERTIFY that the above listed feasibility study has been completed and at least one-half of the invoice amount has been paid up to the amount necessary to receive maximum funds. It also CERTIFIES that itemized invoices from the vendor, photocopies of our canceled checks (front and back), a copy of the feasibility study, and a summary of the study’s usage are attached.

Signature: ______________________________ Title: __________________________

Printed Name: ___________________________ Date: _________________________

Submit to:

Tourism Attraction Feasibility Study Grant Program

Arkansas Department of Parks and Tourism

Tourism Development Section

One Capitol Mall

Little Rock, Arkansas 72201

PH: 501-682-5240