(a) The application shall be in a form prescribed by the Department, in accordance with this subchapter.(b) The application submitted to the Department in accordance with §1.954 of this title (relating to Eligibility for Grant), shall:(1) be notarized and signed by the Organization's executive director and board chair, if applicable;(2) be postmarked not later than November 1;(3) include the following information:(A) the Organization's name and address;(B) the names and titles of the Organization's executive director and board chair, if applicable;(C) the name of the county in relation to which the Organization is applying;(D) the number of residents at least 60 years of age who reside in that county, according to the most recent federal decennial census;(E) the amount of the grant awarded by that county, as required by §1.954 of this title;(F) the total number of meals the Organization delivered to Elderly persons or persons with a Disability in that county during the preceding State Fiscal Year including those that were not Fully Funded;(G) the Organization's most recent financial statement or audited financial report;(H) a list of the Organization's board and officers;(I) appropriate documentation demonstrating that the Organization:(i) is a qualifying governmental agency or nonprofit private organization;(ii) has been awarded a grant by the county for the provision of home-delivered meals to the homebound elderly and disabled in that county; and(iii) has delivered the number of meals reported under subsection (a)(3)(F) of this section; and(J) any other information the Department determines necessary.(c) An Organization that applies for a grant for meals delivered in more than one county must submit a separate application for each county in which the Organization delivers meals.