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<br />MTC Claim Application - Document A(a) <br />Claimant Information <br />FY 2006-07 <br />Submittal Date: 4/20/2006 <br /> <br />Claimant Information <br />I Claimant Name <br />2 Street Address <br />3 City <br />4 ZIP Code <br />5 County <br /> <br />Claimant Personnel Information <br />6 Authorized Signature Name <br />7 Authorized Signature Title <br />8 CFa Name <br />9 CFa Title <br />10 Contact Person Name <br />II Contact Person Title <br />12 Contact Person's Telephone <br />13 Contact Person's FAX <br />14 Contact E-Mail Address <br /> <br />Application Submittal Date <br />15 Fiscal Year <br />16 Claim Submittal Date <br /> <br />Public Transportation Modes Operated <br />Mode Type <br /> <br />17 Demand Response <br />18 <br />19 <br />20 <br />21 <br />22 <br />23 <br />24 <br />25 <br />26 <br /> <br />MTC Programming and Allocations Section February 2005 <br /> <br />Enter requested information in yellow cells <br />Enter requested information using dropdown menu <br />Information appears automatically in cells highlightel <br /> <br />City of Pleasanton <br />5353 Sunol Blvd. <br />Pleasanton <br />94566 <br />Alameda <br /> <br />James W. Wolfe <br />Director of Parks & Community Services <br />David P. Culver <br />Finance Director <br />Pam Deaton <br />Recreation Supervisor <br />925) 931-5367 <br />925) 485.3685 <br />odeaton@ci. oleasanton.ca. us <br /> <br />2006-07 <br />4/20/2006 <br /> <br />Service Name <br />Pleasanton Paratransit Service <br /> <br />Page 10f 1 <br />