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<br />9 <br />FOR THE PARTICIPATING LOCAL GOVERNMENT: <br /> <br /> <br /> <br />Name of Participating Local Government: <br /> <br /> <br /> <br />Authorized signature: <br /> <br /> <br /> <br />Name: <br /> <br /> <br /> <br />Title: <br /> <br /> <br /> <br />Date: <br /> <br /> <br /> <br /> <br /> <br />A Local Government may elect in its discretion to execute the MOU for purposes of this <br />Allocation Agreement only by checking this box (see Paragraph 10.A of this Allocation <br />Agreement): <br /> <br /> <br /> Local Government is executing the MOU in the form attached hereto as Exhibit 3, but <br />which is further amended and modified as set forth in this Allocation Agreement, only for <br />purposes of this Allocation Agreement. <br />