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Grocery/ Supermarket Incentive Program Application (Form 1 of 2)

  1. Town Logo - Economic Development
  2. Grocery/ Supermarket Incentive Program Application (Form 1 of 2)
  3. Applicant Information
  4. Project Information
  5. For Which Elements Does the Company Intend to Request Reimbursement (check all that apply)?*
  6. Estimated Reimbursement Request for Each Element:
  7. ****TOWN OF PRESCOTT VALLEY STAFF USE ONLY****
  8. Approved By:
  9. Town Manager

    sign/ date

  10. Finance Director

    sign/ date

  11. Town Attorney

    sign/ date

  12. Economic Development

    sign/ date

  13. Leave This Blank:

  14. This field is not part of the form submission.