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<br />OMB Number: 4040-0004 <br />Expiration Date: 01131/2009 <br /> <br />Application for Federal Assistance SF-424 Version 02 <br />* 1. Type of Submission: .2. Type of Application: * If Revision, select appropriate letter(s): <br /> I -------------- -~~--J <br />LJ Preapplication 0 New <br /> L -~._- .-.--------..----. <br />0 Application 0 Continuation * Other (Specify) <br /> c=-~~_. .~ - .__u_ , <br />11 Changed/Corrected Application 0 Revision I <br /> I <br />* 3. Date Received: 4. Applicant Identifier: <br />~mPleted by Grants.gov upon submission. I ,- . . J <br />5a. Federal Entity Identifier: . 5b. Federal Award Identifier: <br /> .~ -----------, L-..--~-~--.. ---J <br />I Lo.... ...... J <br />State Use Only: <br /> 1_ 117. L. - . I <br />6. Date Received by State: State Application Identifier: <br /> - -~....,--_._----_.- --..- ------------ <br />8. APPLICANT INFORMATION: <br /> l~a~s.~.ount~, North. Dakota -- . I <br />* a. Legal Name: <br /> ... .. <br />* b. EmployerlTaxpayer Identification Number (EINITIN): . c. Organizational DUNS: <br />[45:6~i205-~=__-~---------~~ ~ l l05~785266 -. J <br />d. Address: <br /> [Po Box 2806 -.... --- . j <br />. Street1: <br /> - ._------_._--_..._-~ <br /> C u _ _~ - --..--.- ._~-=--] <br />Street2: <br /> . .~ <br /> ~1Jll. ---.- .. u__J <br />. City: <br /> - - - ~- .. -..- <br /> [Gass " ~-~_...- ----.------ j <br />County: <br /> C .. _._-~ - I <br />. State: ND: North Dakota <br /> -.......-... ....... ----..- ---r - .. ------~---- <br />Province: I <br /> [~. -.-.. --_._~-----_. 1 <br />* Country: USA: UNITED STATES <br /> .- -- ----...- <br /> @81'O8:2806 .--.-- ~ .. ~ I <br />. Zip / Postal Code: <br /> ... .. <br />e. Organizational Unit: <br />Department Name: Division Name: <br />@asscountYsheliff"------ ._--~---- I ~A .___0'._- .. j <br /> ___.._..._.u " .. ----...- -.-........ <br />f. Name and contact information of person to be contacted on matters involving this application: <br /> __J [~Ie~~_ _' - . .. -- nnn: <br />Prefix: [Mr. . First Name: <br /> ------------ --- ----------- <br /> [Do.U~las ----- ----- ~-- .~ "----~--___=__-J <br />Middle Name: <br /> [Elling!~erg--=_~~~ ---.'---------.- --- ....1 <br />* Last Name: <br /> --,--_.._--~--- ~-~-,_.__._,------ <br />Suffix: [[ I <br />Title: I Government Official = <br /> m -.-.-. . . <br />Organizational Affiliation: <br />l Cass C~u.nt~ S~eriff's Office. -.-----.----..-"'-'-.-- .---- - [I <br /> . ..... . <br /> 1~~~~271~~~4 .. "...." ." 1 l701-271-2967 --.-. j <br />* Telephone Number: Fax Number: <br /> ---------- --~ - ----- ---- _____.__n_.__ ~ -.. ..- -..-- ------------- <br /> --- .. --.. . ~.- ... ----- j <br />. Email: leilingsberg@co.cass.n.d.us <br /> - - .-.- .. -- - --- n - - .. _..._00____- --------------- -.-.. .- - <br />