HomeMy WebLinkAboutOVK Authorized Signers FormSep 14 2010 4:06PM HP LRSERJET FAX
09/13/2010 16:45 FAX
Q 002
P.2
Grant Documents Authorized Signers
Please clearly print or type all sections of this form.
Community/Grantee Name: Kwethluk / Organized Village of Kwethluk
Regutaw Election is bald: A5;rw40K Date:
Authorized Grant Sionerfal:
i
` r i
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/cm munity/municipal official)
Printed Name
Title
Term
Signature
mmntia Cnntaet Infnrmatinn,
Malting Address:
P.O. Box 130
Kwethluk, AK 99621
Phone Number:
907-757-6714 / 6715
Fax Number:
907-757-6328
E-mail Address:
kwtira@unicom-alaska.com
Please use phone or fax for
correspondence due to poor internet
connecfiv'
Federal Tax ID 0:
92-0086578
Please submit an updated form whenever thew Is a change to the above information.
Fftase return the onglnal compieteo torm to:
Alaska Energy Authority
813 W.Northam Lights Blvd. � ENERGY AUTHORM
/4401010 XMKA
Anchorage, AK 89503
Attn: Butch White, Grants Administrator
cweastlo.nwoc nftALASKA PAOJECT SGLVTIaus\CLIENTS\Kwethluk\OVK AEA Grant 2010\00cs for OVK
AEA Signatures\Grant Authorized_Signers4.doc