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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 resholds are met at the time of application <br />C //./7,2ozl <br />of Representative 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 organ ization's representative. <br />of Organization <br />re <br />AOGD <br />Date