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<br /> A.1 <br />CDBG FINAL APPLICATION <br />NORTH DAKOTA DEPARTMENT OF COMMERCE/DCS <br />SFN 52659 (10/11) <br />FINAL APPLICATION COVER SHEET FY ________ 1. LEGAL APPLICANT Applicant Name County <br /> Address (Street, City, State, Zip) <br /> <br /> Local Government Contact Person Phone Number <br /> <br />Email Address <br /> Auditor Phone Number <br /> <br />Email Address <br /> Person Who Completed Application <br /> <br />Phone Number Email Address <br /> Population From Last Official Census <br /> <br /> Project Area Population <br /> 2. NATIONAL OBJECTIVE (Mark One Box) <br /> G Benefit to Very Low/Low <br /> G Elimination of Slums/Blight <br /> G Alleviation of Urgent Need <br /> 3. ELIGIBLE ACTIVITY <br />Which eligible activity listed in Section II of the State <br />Program Distribution Statement does this project <br />comply with? # 4. TITLE OF PROJECT AND BRIEF DESCRIPTION <br /> <br /> <br /> <br /> 5. APPLICANT DUNS NUMBER BUSINESS DUNS NUMBER (ED projects only) <br /> 6. USE OF FUNDS <br />G Construction <br />G Equipment Purchase <br />G Relocation/Acquisition <br />G Special Assessments <br />G Removal of Architectural Barriers <br />G Public Service <br />G Other <br /> 7. PROPOSED FUNDING <br />a. CDBG Project Cost <br />b. CDBG Administration <br />c. Local Funds <br />d. Other Funds <br />e. Other Administration <br />f. Total Costs <br /> <br />$ <br /> <br /> <br /> <br /> <br />$ <br />8. IS ANY PORTION OF THE TOTAL COSTS BEING SPECIAL ASSESSED? G Yes G No 9. PROJECT START DATE <br /> <br /> 10. PROJECT DURATION <br /> 11. APPLICANT CERTIFIES THAT <br /> To the best of my knowledge and belief, data in this application are true and correct, and the document has been duly authorized by the governing body of the applicant. <br />NAME <br /> <br />TITLE <br /> SIGNATURE CHIEF ELECTED OFFICIAL X <br /> DATE <br />