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Form Approved <br />OMB No. 63•S•75013 <br />US. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT <br />COMMUNITY DFVELOPMENT BLOCK GRANT PROGRAM <br />SATISFACTION OF CONDITIONAL APPROVAL <br />SERVICES AND/OR FACILITIES <br />1. NAME OF APPLICANT. - <br />2. APPLICATION/GRANT NO. <br />Indian River County <br />B -76 -DN -12-0012 <br />3. APPLICANT ADDRESS (include Street, City, County, State and Zip Code) <br />4. DATE OF REQUEST <br />Indian River County Courthouse <br />1976 <br />34th Avenue <br />'hero Beach, Florida 32960 <br />s. DATE OF FUNDING APPROVAL <br />July 26, ,1976 <br />6. IIUD authorization is requested for utilization of the conditionally approved grant amounts for the services and <br />facilities shown below, in accordance with the requirements of Item 17 of the Funding Approval. <br />(A) Public services determined necessary or appropriate for which other Federal assistance is not available: <br />Services Amount Grantee <br />i <br />(B) Flood or -drainage facilities for which other Federal assistance is not available: <br />Facilities Amoun Grant <br />Street Drainage $20,000. Indian River County <br />See Attached Sheet <br />7, IT IS HEREBY CERTIFIED, FOR EACH nF THE SERVICES AND/OR FACILITIES LISTED ABOVE, THAT PURSUANT <br />TO THE PROVISIONS OF 9570.607 OF THE HUD COMMUNITY BLOCK GRANT REGULATIONS, OTHER FEDERAL <br />FUNDS HAVE BEEN SOUGHT AND ARE NOT AVAILABLE. <br />TYPED NAME AND TITLE OF AUTHORIZED RCPRESENTATIVE OF APPLICANT <br />Telephone Number <br />Willard 1•11. Siebert, Jr. <br />....Honorable <br />Chairman,Indian River Count Cormission AREA NUMBER EXT. <br />SiGWATURE FA £D R RESE AT /L/ CODE <br />Q2305 562-41$6 <br />Me 1 United Stfstes C Code Criminal Procedure} foregoing <br />WA N'G—SC Mofi 11DO1 of T of the o [ urinal end stual! ply to rtes <br />Certification. Title Te provides, among other things, that whoever knowingly and willfully makes or uses a document or writing cental ting <br />any false, fictitious, or fraudelent statement or entry, in any matter within the jurisdiction of any department or agency of the United <br />State.,, shall be fined nbt more than S16,000 or imprisnned not more than five years, or both. <br />8. HUD AUTHORIZATiON The above request is hereby approved. <br />AMOUNT AUTHORIZED S <br />TYPE NAME ANO TITLE OF AUTHORIZING OFFICIAL <br />SIGNATURE OF AUTHORIZING OFFICIAL <br />DATE <br />