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Applicant Certification <br />Certification is hereby given that the information provided is accurate and the applicable <br />attachments are complete and included as part of the application package. <br />I certify that application thresholds are met at the time of application. <br />Signature W1 Official Representative <br />Sponsoring Agency <br />(if Applicable) <br />Signature of Agency Representative <br />Typed or Printed Name <br />Date <br />Date <br />Date <br />