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AUTHORIZATION <br />Acceptance of this application may be subject to subsequent compliance reviews, including a review <br />of the latest audit of financial statement. Preparation of an application does not guarantee that <br />applicants will receive funds. By signing this grant application form the undersigned certifies that all <br />information is accurate to the best of his/her knowledge. <br />__________________________________ ____________ <br />Signature of Authorized Representative Date <br />3