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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 />1 certify that application resholds are met at the time of application. <br />,)q�C � <br />�r �� r <br />SiJaAureJof Offigial Representative Date <br />Sponsoring Agency <br />(if Applicable) <br />Signature of Agency Representative Date <br />Typed or Printed Name <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 />. a cworr� <br />Na a of Organization <br />'gnature o epresentative <br />Date <br />