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Applicant Certification <br />Certification is hereby given that the information provided is accurate and the applicable attachments are <br />complete and included as part of the application package. <br />I certify that application thresholds are met at the time of application. <br />Signature of Agency Representative <br />Typed or Printed Name <br />Sponsoring Agency <br />(If Applicable) <br />Date <br />Date <br />Date <br />AHociate Economic Development Organization Notification <br />The organization listed below has received notification of this application as demonstrated by the <br />signature of the organization's representative. <br />Date <br />Kitti fas County Department of Public Works Receipt of Application <br />Signature of Kittitas County DPW Representative Date <br />Typed or Prtinted N~mie <br />12