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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 />I certify that appl;lag <br />hresholds are met at the time of application. <br />0:�L. <br />2022 <br />Sig ure of Official Representative Date <br />Sponsoring Agency <br />(If Applicable) <br />Signature of Agency Representative <br />Typed or Printed Name <br />Date <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 />C0: C40bW 0f Coram <br />3a e of Organization <br />i tature 4t R presentative <br />I%/aflaa <br />Date <br />11 <br />