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<br />INSTRUCTIONS: <br /> <br />a. Press F1 for help for each field. <br />b. Navigate through the form by using the TAB key or the mouse to highlight and enter data in each field. <br />c. All Questions in RED are required. <br />d. Documents attached must be in version WORD 97 or above or WORDPERFECT 6.0 or above. <br /> <br />(R8-PA-5/1/2004) <br /> <br />-------------------------------------------------------------------------------------------- <br />-------------------------------------------------------------------------------------------- <br /> <br />Please print this page - original signatures are REQUIRED. <br /> <br />Authorization <br /> <br />The undersigned does hereby submit this application for financial assistance in accordance with the Federal <br />Emergency Management Agency's Hazard Mitigation Grant Program and the State Hazard Mitigation <br />Administrative Plan and certifies that the applicant (i.e., organization, city, or county) will fulfill all requirements <br />of the program as contained in the program guidelines and that all information contained herein is true and <br />correct to the best of our knowledge. <br /> <br />Signature ~ ~ <br />Applicants' Agent <br />Type name ~0D+--r Woq(\eJ, thlirr'YlLW (OlSS' Cv~ Comm;S~'; 0 VI <br /> <br />Date 6~ 1 - D 1 <br /> <br />Date 1/;b /1 1 <br />/ ' <br /> <br />Signature <br /> <br />Chief Executive Officer <br /> <br />Type name <br />Organization GLs ~ CJ \ln~ GD V er Y1 rYI en t <br /> <br />Type name of organization <br /> <br />37 <br />