Hudson County

Division of Planning

HUDSON COUNTY OPEN SPACE, RECREATION,

AND HISTORIC PRESERVATION TRUST FUND

2022 EXTENTION REQUEST

APPLICANT INFORMATION

APPLICANT:

Name of applicant (municipality/organization):

Applicant address:

City

State

Zip Code

CHEIF EXECUTIVE OFFICER:

Name, Title

Email Address

Phone Number

PRIMARY CONTACT:

Name, Title

Email Address

Phone Number

Street address:

City

State

Zip Code

SUPPORT STAFF (OPTIONAL):

Name, Title

Email Address

Phone Number

SUPPORT STAFF (OPTIONAL):

Name, Title

Email Address

Phone Number