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Applicant Certifi cation <br />Certification.is hereby given that the information provided is accurate and the appticable attachments arccomplete and included as pan of rhe application package. <br />I certify that application thresholds are met ar the time of application. <br />// l? zaz/ <br />Signatu re of Representative Date <br />Sponsoring Agency <br />(lf Applicable) <br />Signatu re of Agcncy Representative Ilatc <br />Typed or Printed Name Date <br />A.ssociate Economic Development Organization Notification <br />The organization listed belou' has receivcd notification of this project as demonstrated b.1,1t1s <br />signatu re of the olga n iza tion's rep resentative. <br />Name Organization <br />re of <br />CEo tt/r t/aoat <br />Date <br />5