HomeMy WebLinkAboutGrant_Authorized_Signers4C:\Users\nhowes\Desktop\NDH Docs to add to library\REF\Applications Received for Round 4\677_Akiak Hydro
Study\Grant_Authorized_Signers4.doc
Grant Documents Authorized Signers
Please clearly print or type all sections of this form.
Community/Grantee Name:
City of Akiak
Regular Election is held:
October
Date:15 Sep 10
Authorized Grant Signer(s):
Printed Name Title Term Signature
Debra Jackson Mayor 1
Amelia Nicolai Bookkeeper
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name Title Term Signature
Debra Jackson Mayor 1
Grantee Contact Information:
Mailing Address:
P.O. Box 52028, Akiak, AK 99552
Phone Number: 765-7411
Fax Number: 765-7414
E-mail Address: Bobby41@unicom-alaska.com
Federal Tax ID #:
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
C:\Users\nhowes\Desktop\NDH Docs to add to library\REF\Applications Received for Round 4\677_Akiak Hydro
Study\Grant_Authorized_Signers4.doc
Attn: Butch White, Grants Administrator