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Attestation <br />Local Support Grant Request <br />I am the County Administrator (title of principal officer) of <br />Indian River County (organization or entity) for which <br />a Local Support Grant Request Form was submitted. I have read such Request Form # as <br />published on the Florida House of Representatives website, and I verify that I am fully informed as to <br />the information therein. I declare that all such information is true and accurate OR ❑ (check if <br />correction attached) is true and accurate as corrected in the attached statement. <br />I am authorized on behalf of the organization or entity listed above to and do consent to investigation <br />of such information and any matter relevant thereto. I agree to provide all documents and other <br />information requested by the Chair of the House Public Integrity & Elections Committee as part of such <br />investigation, including information that may be requested on the organization, ownership, and any <br />beneficiary of the organization or entity on whose behalf project funding has been requested. <br />If any inaccuracies in the information contained in the Local Support Grant Request Form come to my <br />attention, I agree to promptly correct such information by letter to the House Appropriations <br />Committee. <br />Under penalties of perjury, I declare that I have read the foregoing statement and that the facts <br />stated in it are true. <br />Signed: <br />_V <br />Print name: J GI.SUrI m l- n <br />Date: T uJ , % , c C,) .) 2 <br />Entity name: I vAA � 0-n._ 1Z t VC -1,1— Co w\ Jt - <br />The completed and signed attestation, as well as any subsequent letters of correction, should be submitted <br />to the Appropriations Committee by electronic mail to the following address: apc@laspbs.state.fLus. <br />The deadline to submit an Attestation Form is August 10, 2022. <br />