HomeMy WebLinkAboutF_AuthSignerForm_WasteHeatReconGrant Documents Authorized Signers
Please clearly print or type all sections of this form.
Community/Grantee Name: Eklutna, Inc.
Regular Election is held: Annually Date: 3` Saturday of November
Authorized Grant Sianerlsl:
Printed Name
Title
Term
Signa re
Curtis McQueen
CEO
5 years
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name
Title
Term
Signature
Curtis McQueen
CEO
5 years
U
Grantee Contact Information:
Mailing Address.
16515 CENTERFIELD DRIVE, SUITE 201
EAGLE RIVER, ALASKA 99577
Phone Number:
907-696-2628
Fax Number:
907-696-2945
E-mail Address:
curtis@eklutnainc.com
Fiscal Year End:
December 31
Entity Type (For -profit or non-profit status):
For -profit
Federal Tax ID #:
92-0044666
Please submit an updated form whenever there is a change to the above information.
Please return the original completed form to: ALAS M
Alaska Energy Authority
813 W. Northern Lights Blvd.
Anchorage, AK 99503 /41CDENERGY AUTHORITY
Attn: Butch White, Grants Administrator
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