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ORIGINAL <br />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 />Stn ut of O cial Representative <br />Sponsoring Agency <br />(If Applicable) <br />Signature of Agency Representative <br />Typed or Printed Name <br />Date <br />Date <br />Date <br />Associate Economic Development Organization Notification <br />The organization listed below has received notification of this project as demonstrated by the <br />signature of the organization's representative. <br />4-G. C6mber.f ammfyC-C, <br />CNmeof Organization <br />coo <br />Signature epresentative <br />T4. q th, 2021 <br />Date <br />10 <br />