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<br />ApPLICATION AUTHORIZATION <br /> <br />6.3A <br />Page 11 <br /> <br />This application was prepared by: <br />Teri Chin <br />Name <br /> <br />Human Services Manager <br />Title <br /> <br />Signature <br /> <br />1/13/10 <br />Date <br /> <br />This application Is submitted by: <br /> <br />I/We certify that the information and statements submitted in and attached to this application, are <br />true, accurate and complete to the best of my/our knowledge. I/We authorize the Department of <br />Housing to verify any information pertaining to this application. I/We acknowledge and understand <br />that if facts and/or information herein are found to be misrepresented, it may constitute grounds for <br />rejection of the application or default of the allocation for which this application is being made. <br /> <br />T eri Chin <br />Name <br /> <br />Human Services Manager <br />Title <br /> <br />Signature <br /> <br />Date <br /> <br />Name <br /> <br />Title <br /> <br />Signature <br /> <br />Date <br /> <br />Please tab to next page for list of required attachments. <br /> <br />NOFA FY 2010-11 Rehabilitation Program Application <br />