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AUTHORtZATtOT{ <br />Acceptance of thls application may be subject to subsequent compliance reviewr, includlng a review <br />of the latest audit of flnanclal statement. Preparation of an appllcation does not guarantee that <br />applicants wlll reseive funds. By signing this grant application form the underslgned cerflfles that all <br />Informatlon ls accurate to the best of hislher knowledge. <br />Signature of Authorized Representative <br />de-+l>a <br />Date <br />3