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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 />flail- Gn d)It f.b 2,7a* I <br />Signature Date <br />Sponsoring Agency <br />(If Applicable) <br />Signature of Agency Representative Date <br />Typed or Printed Name Date <br />Associate Economic Development Organization Notification <br />The organization listed below has received notification of this project as demonstrated by the <br />signatu re of the organization ts representative. <br />Name of Organization <br />Signature of Representative Date <br />7