HomeMy WebLinkAbout4 - Kipnuk Grant Signers FormSEP-14-2010 13:18 From:To:19076771886
Grant Documents Authorized Signers
Please clearly print or type all sections of this form.
Regular Election is held:N/A I Date:9/13/10
Community/Grantee Name:Kipnuk Light Plant
---------------.I ----
Printed Name Title Term Signature
Sam Carl General Manager N/A
(~~
Jimmy Paul Tribal Administrator N/A .......c:.,
~fI..A--
L/
I authorize the above person(s)to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Pri nted Name Term SignatureTitle
Sam Carl General Manager
Grantee Contact Information:
Mailing Address:PO Box 071,Kipnuk,AK 99614
Phone Number:907 -896-5427
Fax Number:907 -896-5022
E-mail Address:scarlklp@yahoo.com
Federal Tax ID #:q:l-a 11100 q
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.Northem Lights Blvd.
Anchorage,AK 99503
Attn:Butch White,Grants Administrator
ALASKA
ENERGY AUTHORITY
C :\DOCUME -1 \ADMINI-1 \LOCAl.S-l \T em p\fcctemp\Kipnuk GranCAuthorized_Signers4.doc