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<br /> <br />Other <br /> <br /> <br /> $ $ <br />Fri $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br />_ Rent: $ $ <br />ui ment: $ $ <br />Insurance: $ $ <br />PhoneIFax: $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ <br /> $ $ <br /> <br />Other <br /> <br />PP~RATlONS . <br /> <br />12. ..CERl'IFlCAl'ION <br /> <br />I certify that the information contained In this application Is true and correct and that It contains no misrepresentations, falsifications, <br />Intentional omissions, or concealment of material facts. I further certify that no contracts have been awarded, funds committed or <br />construction begun on the proposed project, and that none will be prior to issuance of a Release of Funds by the program <br />administrator. <br /> <br /> <br /> <br />SIgnature of Authorized OfficIal <br /> <br />Name of Authorized OfIiclal <br /> <br />TIlle <br /> <br />Date <br /> <br />Page 4 <br />