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Applicant Certification <br />Certification is hereby given that the information provided is accurate and the applicable <br />attachments are complete and included as part of the application package. <br />I oertfFy at a thresho met at the time of application. <br />Sign al Reprre Date <br />Sponsoring Agency <br />(V Applicable) <br />Signature of Agency Representative Data <br />Typed or Printed Name Date <br />Associate Economic Development Organization Notification <br />The organization listed below has received no hi ation of this project as demonstrated by <br />the signature of the organization's reps eseW ative. <br />df ,?o17 <br />ia� <br />Illttltas County Department of Public Works Conceptual Approvals <br />Approval of the project feasibility, scope and estimated costs. <br />Signature of iCittl s County DPW Representative <br />Typed or Printed Name <br />