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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 ce ica n thresholds1are met at the time of application. <br />Signature oÏOfficial Representative Date <br />SponsoringAgency <br />(If Applicable) <br />Signature of Agency Representative Date <br />Typed or Printed Name Date <br />Associate Economic DevelopmentOrganization Notification <br />The organization listed below has received notification of this project as demonstrated by the <br />signature of the organization's representative. <br />Name of Organization <br />Signature of Representative Date <br />7