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<br />MISCELLANEOUS CHECKLIST <br /> <br />THIS CHECKLIST SHOULD NOT BE USED WITHOUT PRIOR APPROVAL FROM THE CHIEF CLERK. <br /> <br />1. Reason for the request is explained. <br /> <br />2. Will any funding be required for this item? Yes No ~ <br />If yes, please explain in "Comment" section beloW-:-- <br /> <br />INI~/DEPT. <br /> <br />3. Required signatures: <br />a. Department Director - Signature/approval <br />b. County Attorney - Signature/approval <br />c. Budget & Accounting - Signature/approval <br />d. Risk Management - Signature/approval <br /> <br />~ <br /> <br />4. Draft of County Board Resolution (If applicable): <br />Include the reasons for the action: WHEREAS <br />Include in draft the exact action you are requesting <br />of the County Board: RESOLVED. <br /> <br />.~ <br /> <br />5. Grammar, spelling and math is double-checked on each document. <br /> <br />rrJ¿ <br /> <br />6. Draft resolution (if applicable) approved by Chief Clerk. <br /> <br />Comments: <br /> <br />~~ <br /> <br />Preparer's Signature <br /> <br />&~?I <br /> <br />Telephone <br /> <br />9 - 6./ c¡ ) <br />Date <br /> <br />CERTIFICATION STATEtlENT <br />Documentation certified complete for: <br /> <br />Committee/Meeting Date Signature Date <br />Committee/Meeting Date Signature Date <br />County Board Date Signature Date <br />