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Attachment k <br /> Cam Leh -Wqoiw <br /> 'M C Q8 G, <br /> 111E A <br /> SIGNATURE F0FM <br /> SIP <br /> ­., . .. _F . AUG 24 <br /> ablnit an A <br /> U &M Wo <br /> Recipient co!ltact PUN <br /> S <br /> umber <br /> Indian River.Cou 101)&4*4090-01+13 031120M. <br /> Mailing Address(Street or Post Office Box) <br /> 1801271'Street <br /> City,State And Zip.Code <br /> .)Lqpo Beach <br /> Florida.32960-3388 <br /> Project Gontpct Person Tele'hone <br /> AR?) ....... <br /> Robert M.'Kiiatin6,Community Development Director E-7mall Address A. <br /> bkedtlWfeir�aiov, <br /> ---------- <br /> Financial Contact Person Telephone it', <br /> .(772)226-1205 <br /> Diane Bernardo-FInaru Diredw E-mail AddInm <br /> dbe0nard erli.indiark-river.orq <br /> ii!F[WFunds(RFFs) mall Cities CDBG Program reqWi*:(0*&orie)J Jone sl0na;#te E 'I two <br /> signatums of individuals authorized below. No more thantwo indiviftali can be authoritiad'to use. <br /> FloridaPAPERS. C6i=Gi,:'­11' <br /> 1contracts <br /> IM <br /> t1racts requIre tog <br /> hat at hDire(1)RFFs must be submittied ell quarter and should reflect:ad ;n'd <br /> ,. <br /> Incurred diuWdn that rapoMn <br /> I pglod. <br /> yped'Name <br /> T Da <br /> S <br /> XJ.Check here if the above person will 6e the <br /> E-mail Ad*ess' <br /> '_OgIpAt OdaPAP bke n ov <br /> ERS user. _qVig <br /> go-com <br /> I Typed Narpe Date SlOature <br /> IT'4Check here W&ea ve person will be the E-thall,Address <br /> E <br /> UIDLdg FloddaPAP RS user. <br /> ------_ - <br /> Typed Name Date 'Tignattire <br /> ---------- ...... <br /> TJ om&l7ere If the <br /> -abovepersonwIllbethe E-mall:Addre <br /> ss <br /> designated FloridaPAPERS useri <br /> I certify,as the redplenVs Chief Elected Official,that the above signatures are of WNW*a iUwrizai to sigh <br /> :Fuiids and to suMit RFIF's ele(ArunIcally to the Small Cities Cornrriuiilty uAn*FbftPAPERS: <br /> • TVj7ea NarW' Date e <br /> Wesley S;.Davis.BCC Chairman <br /> X)Check-herie Ifyour.local government utilizes Ekctrdnic Funds Transfer(EFr)fro4i the StitSofiflcWida. <br /> Check here 0 your 1601 <br /> grahi,check here I III ­ <br /> if this signature authority form pertains to a housIn Ovio�yr.W qq use an e5crow,account <br /> .90"Mrilint4will be working on a refiribursinient.". <br /> for <br /> housing aiWii <br /> iqDK paymOMIoA:kW.OvemMer&ij*ing.FFTore.automaticallydeposlt6d.lhthe:lmI-government s general Aram-account; if the <br /> account is interest bearing,the COBG funds'rndsi tie iransferik to 6 rich4t6rest tieadngl I <br /> awount P eait6 call the CDM <br /> Priigrprriat 650/.022-1878 or 487,-3644 If you have:questions. You can*.dwtk the status of yourdip"t at the Coniipki6llers <br /> 'Website. <br /> Provide-acc0urit'InfbhTk*dn for the financiallristitiition(insured byrDic bie •Al: re�one ccount;mUstbe'boh(W' <br /> 'Waiiiofii4lknW�WWstiIFAF66 Account Number° <br /> -7 <br /> RBC Bank, 053100850680027195 <br /> streetAddressbr Post:Offleh Box Telephone Number' <br /> 1417 Cetrtura HI'h <br /> Alty Stifte'aild Zip Code_ <br /> 2760 <br /> 3.1 <br /> J. <br /> J <br /> V;1 <br /> K <br /> YZ <br />