Laserfiche WebLink
15 Data Disclosure <br /> Under Minn. Stat. § 270C.65,and other applicable law,the Grantee consents to disclosure of its social security <br /> number, federal employer tax identification number, and/or Minnesota tax identification number,already provided to <br /> the State,to federal and state tax agencies and state personnel involved in the payment of state obligations. These <br /> identification numbers may be used in the enforcement of federal and state tax laws which could result in action <br /> requiring the Grantee to file state tax returns and pay delinquent state tax liabilities,if any,or pay other state liabilities. <br /> 1. ENCUMBRANCE VERIFICATION 3. STATE AGENCY <br /> Individual certifies that funds have been encumbered as <br /> required by Minn.Stat.§,¢16A.15 and 16C.05. <br /> Signed: By: <br /> (with delegated authority) <br /> Date: Title: <br /> Grant Contract No.: 2008-T5-00416/6300-2520 Date: <br /> 2. GRANTEE <br /> The Grantee certifies that the appropriate person(s) <br /> have executed the grant contract on behalf of the Grantee as <br /> required by applicable articles,bylaws, resolutions,or ordinances. <br /> By: <br /> Title: <br /> Date: <br /> By: <br /> Title: <br /> Date: <br /> Distribution: <br /> Agency <br /> Grantee <br /> State's Authorized Representative <br /> Title V JABG Title II Combined(11/07) <br /> Title V Juvenile Justice Renewal 08 6 <br /> OJP Grant Number 2008-T5-00416 <br />