HomeMy WebLinkAboutAEA RoundIV signatory sheetGrant Documents Authorized Signers
Please clearly print or type all sections of this form.
1 Community/Grantee Name: The Lake and Peninsula Borough ~
(Regular Election is held: Every November fOale: 9/15/2016---~ m I
Authl:'rized Grant Signer(s):
I Printed Name .1 ~it~le___~1 Term
! 1Lamar Cotten Borough Manager IL L
k
, Jordan Keeleri Communitym 1--'
I Development
I Coordinator
Richard E. Wallaee---tl---;;F::-inm.ance Officer
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I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name Title
Grantee Contact Information:
Mailing Address: I PO Box 495
I 'Kin Salmon, AK 99613 fm--.. ~-~~-~ I Phone Number: 907-246-3421 I
miFax Number: 907-246-6602 --1
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io rda nkeeler@lalSiEl['j<:lpen,com
Federal Tax ID #:
L-______________~!~92~-~01289~22~__
I Ple~se sUbmit an~pdate~ form~henevE!r the~~ is a change t~ the a~ove information. J
Please return the original completed form to:
Alaska Energy Authority / .:;) AlASKA813 W. Northern Lights Blvd.
tcS, ) ENERGY AUTHORITYAnchorage, AK 99503
Attn: Butch White, Grants Administrator
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