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f <br /> [Runding Matrix <br /> e applicant must provide the funding matrix shown below, fisting each program for which HUD funding is being <br /> uested, and complete the certifications. <br /> Grant Program' HUD Appricant Other HUD Other Fede ra State Local/Tribal Other Program Total <br /> Share Match Funds Share Share Share Income <br /> 0 . 00 <br /> 0 . 00 <br /> 0 . 00 <br /> 0 . 00 <br /> 0 . 00 <br /> Grand Totalsl 0 . 00 0 . 00 0000 0 . 00 o . 00 0 . 00 0 . 00 0 . 00 0 . 00 <br /> For FHIPs, show both initiative and component <br /> Certifications <br /> I certify, to the best of my knowledge and belief, that no Federal appropriated funds have been paid, or will be paid, by or on behalf <br /> Of the applicant, to any person for Influencing or attempting to Influence an officer or employee of an agency, a Member of <br /> Congress, an officer or employee of Congress, or an employee of a Member of Congress, In confection with the awarding <br /> of this Federal grant or its extension, renewal, amendment or modification. ff funds other than Federal appropriated funds have <br /> or will be paid for influencing or attempting to influence the persons Wed above, I shall complete and submit Standard Fom>-LLL, <br /> Disclosure Form to Report Lobbying. I certify that I shag require all sub awards at all tiers (Indudktg sub-grants and contracts to <br /> similarly certify and disclose accordingly. ) <br /> Federally. recognized Indian Tribes and tribally designated housing entities (TDHEs) established by Federally-recognized Indian tribes <br /> as a result of the exercise of the tribe's sovereign power are excluded from coverage of the Byrd Amendment, but State-recognized Indian <br /> tribes and TDHEs established under State haw are not excluded from the statute's coverage. <br /> This application Incorporates the Assurances and Certifications (HUD-424B) attached to this application or renews and incorporates for <br /> the funding you are seeking the Assurances and Certifications currently on file with HUD. To the best of my knowledge and belief, all <br /> information in this application Is true and correct and constitutes material representation of fad upon which HUD may rely In awarding <br /> the agreement <br /> 23 . Sign of Authortz Offid Name (printed) <br /> Title Kenneth R . Macht <br /> Chairman Date (mm/dd/mmyy) <br /> 07 / 08 / 2003 <br /> Previous versions of HUD-424 and 424-M are obsolete. Page 2 of 2 form HUD-424 (01 /2003) <br /> ref. OMB Circular A- 102 <br />