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Private Non Profit Assurance Statement by NASSdocs

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									3. PRIVATE, NON-PROFIT ASSURANCE STATEMENT (REQUIRED FOR
NON-PROFIT ORGANIZATIONS ONLY)

Non-profit organizations must complete the information below, sign and include this
assurance statement with their proposal.

FNS provides an electronic copy of this format at
http://www.fns.usda.gov/fsp/outreach/default.htm.

Assurances:

 Check [√] each       Assurance Statement
 item below to
 indicate you have
 read and             Upon request, my non-profit organization will provide FNS
 understand each      with:
 statement.
                      A copy of the IRS Determination Letter, form 501(c)(3), or proof
                      of application for exempt status under section 501(c)(3) of the
                      Internal Revenue Code.
                      A list of the Board of Directors.
                      The most recent audit of the organization’s financial records. (If
                      your organization has not had an audit, a financial statement
                      signed by the Treasurer of the Board will suffice.)

By signing below, the organization and organization’s representatives certify that the
above assurances are met. If any of the above assurances cannot be met by the
organization to the satisfaction of FNS, the organization may be eliminated from
consideration for a grant. Public organizations are not required to submit the documents
listed above.

Name and Address of Private, Non-profit Organization:

Name of Authorized Representative:

Signature of Authorized Representative:                                   Date:

								
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