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ORIGINAL <br />Applicant Certifi cation <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 appl thresholds are met at the time of application. <br />L1 <br />/rt c <br />A,&.2-n-2t <br />of Representative Date <br />Sponsoring Agency <br />(If Applicable) <br />Signatu re of Agency Represen tative Date <br />Typed or Printed Name Date <br />Associate Economic Development Organization Notilication <br />The organization listed below has received notification of this project as demonstrated by the <br />signatu re of the organ ization's representative. <br />of <br />N of Organization <br />&0 Tr,a. qhr,aD?A <br />Signature Date <br />l0