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Applicant Certification <br />Certification is hereby given that the infonnation provided is accurate and the applicable attachments are <br />complete and included as part of the application package. <br />I certifu that application thresholds are met at the tirne of application. <br />S, , .')7 jc')I <br />Sign ature Official 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 />signature of the organization's representative. <br />ldn a $,anb,r,l <br />Name of O rganization <br />tolozl*a <br />S Date <br />7