; Authorized Signature Form For Grant Funds
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Authorized Signature Form For Grant Funds

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									CITY OF COMMUNITY DEVELOPMENT BLOCK GRANT

AUTHORIZED SIGNATURE FORM Name and Address of Agency Name of Program

INSTURCTIONS: A signature Form is to be submitted for the person(s) authorized to sign grant drawdown request for payment and status of funds report(s). The form should contain signature of two (2) or more authorized persons in order to provide alternatives in case of illness or other emergencies.
SIGNATURES OF INDIVIDUALS AUTHORIZED TO REQUEST DRAWDOWNS

Typed Name

Title

Signature

Typed Name

Title

Signature

Typed Name

Title

Signature

I certify that the signatures above are of the individuals authorized to request payment of grant funds.

Signature of Board President

Date


								
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