HomeMy WebLinkAboutR7 Authorized Signers FormRenewable Energy Fund Round VII , M
Grant Application - Standard Form f 41IU ENERGY AUTHORITY _
SECTION 10—AUTHORIZED SIGNERS FORM
Community/Grantee Name: NATIVE VILLAGE OF CANTWELL
Regular Election is held: Date:
AT THE END OF JANUARY
Authorized Grant Signer(s):
Printed Name
Title
Tema
Signature
RENE NICKLIE
PRESIDENT
1 YEAR
wz ,
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name
Title
Term
Signature
RENE NICKLIE
PRESIDENT
1 YEAR
Grantee Contact information:
Mailing Address:
PO Box 94
Cantwell, AK 99729
Phone Number:
907-768-2591
Fax Number:
907-768-1111
E-mail Address:
hailvc@mtaonline.net
Federal Tax ID #:
92-0046670
Please submit an updated form whenever there is a change to the above information.
AEA 2014-006 Grant Appikation Page 19 of 20 7Mi2013