Laserfiche WebLink
<br />I, <br /> <br />Name <br /> <br />officer of <br /> <br />Authorization <br /> <br />, do hereby certify as the authorized representative or <br /> <br />, that the information contained in this <br /> <br />Name of Organization <br /> <br />application is true and correct. <br /> <br />Title <br /> <br />Signature <br /> <br />Date <br /> <br />CalEMA 89 (Rev. 01/02/09) 4 <br /> <br />6.2E <br />Page 6 <br />