HomeMy WebLinkAboutAuthorized Signers DocumentGrant Documents Authorized Signers
Please clearly print or type all sections of this form.
Community/Grantee Name:
Port Graham Village Council
Regular Election is held: Date: 2 nd Tuesday in February
Annualiv
Authorized Grant Signer(s):
Printed Name
Title
Term
Signature
N/A
N/A
N/A
N/A
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name
Title
Term
Signature
Patrick Norman
Chief
4 years
- �^
Grantee Contact Information:
Mailing Address:
P.O. Box 5510
Port Graham, Alaska 99603
Phone Number:
907-284-2227
Fax Number:
907-284-2222
E-mail Address:
normanvc hotmail.com
Fiscal Year End:
December 31
Entity Type (For -profit or non-profit status):
Non-profit
Federal Tax ID #:
92-0064336
Please submit an updated form whenever there is a change to the above information.
Please return the original completed form to:
Alaska Energy Authority
813 W. Northern Lights Blvd.
Anchorage, AK 99503
Attn: Butch White, Grants Administrator
/IIIIIIIIIIED ENERGY AUTHORITY
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