Robert C. Smith passed away at
the age of 84, leaving behind him a distinguished legacy of community service and the formation of a charitable foundation which will continue to give for years to come.
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Januray 1st, April 1st
July 1st, October 1st
William Troxell, President
William Acee, Vice President
Richard M. Runyon, Treasurer
Thomas C. Emerson, Secretary
Betsey Baio, Gary Brookins,
Mary W. Davis, Nancy Ritzel,
Pegi S. Lopresti
Gary Clark, Executive Director
John Tiguin, Honorary Director
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Applicant Organization, Name & Address.
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Identify the specific purpose and amount of your request. Identify who will benefit and how
It relates to your not-for-profit purpose.
Identify the contact person by name, address, and phone number and the person responsible
for administering the grant proceeds.
Submit a narrative or organizational material to describe your purpose, programs and abilities to
carry out the proposed activities.
Is the applicant organized as a nonprofit organization under the NY State laws governing charitable organizations?
Has the applicant received a ruling or determination letter from the I.R.S. about exempt status?
Or Foundation status? Or grant making status? Provide copy.
Is the applicant controlled by, related to, connected with or sponsored by another organization?
If yes please identify.
Submit a listing of Board members and Officers.
Attach copies of the following pages from your most recent IRS Form 990. Page 1, 7, 9, 10, & 11.
Submit a copy of your most recent budget.
Please list the local foundation awards or United Way monies received within the past 12 months.
Please list grant requests pending to local foundations or the United Way.
Please have an agency officer attest to the accuracy of all information submitted as part of this application and the authority to submit same.
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Title and Date
Attachments are encouraged where necessary.
