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418 <br />4CKNOWLEDGMENT OF NOTICE BY LOCAL GOVERNING BODY <br />IName of L,ocpl Governing Body iC,My or County) <br />C 0'.:- <br />Township Nl amie JMust be notified when County is the approving body) <br />Sign eturEFUIPerso Receiving Application iL Signature of Person Receiving Application <br />Title f. - Date Received Title <br />C,G-0010120-0 1 (4/861 Whit Board Canary — Board returns to Organization to keep <br />Pink — Organization Gold — City or County <br />Date <br />