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Applicant Certification <br />Certification is hereby given that the information provided is accurate and the applioable attachments are <br />complete and included as part of the application package. <br />I certifu that applicati resholds are met at the time of application. <br />o€f. 6 2ozL <br />Official Representative Date <br />Sponsoring Agency <br />(If Applicable) <br />Signature of Agency Representative Date <br />Ilped or Printed Name Date <br />Associate Economic Development Organization Notification <br />The organization listed below has received notilication of this project as demonstrated by the <br />signature of the organization's representative. <br />f <br />a <br />of 0rganization <br />t w p/alanae <br />Date <br />ll