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2015_0723_CCpacket
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2015_0723_CCpacket
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8/7/2015 9:01:10 AM
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7/16/2015 3:28:54 PM
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its social security number, federal employer tax identification number, and/or Minnesota tax <br />identification number, already provided to the State, to federal and state tax agencies and state <br />personnel involved in the payment of state obligations. These identification numbers may be used in <br />the enforcement of federal and state tax laws which could result in action requiring the Grantee to file <br />state tax returns and pay delinquent state tax liabilities, if any. <br />1. STATE ENCUMBRANCE VERIFICATION - ; <br />Individual certifies that funds have been encumbere�� :' <br />required by Minn. Stat. §,16A.15 and 16C.05. <br />Signed: �� <br />Date: � ��— � --� <br />SWIFT Contract/PO No(s). S� �=� � <br />2. GRANTEE <br />The Grantee certifies that the appropriate person(s) have <br />executed the grant contract on behalf of the Grantee as required <br />by applicable articles, bylaws, resolutions, or ordinances. <br />By: <br />Title: <br />Date: <br />By: <br />Title: <br />Date: <br />Automobile Theft Prevention Grant Program FY 16-17 <br />3. STATE AGENCY <br />By: <br />(with delegated authority) <br />Title: <br />Date: <br />
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