Laserfiche WebLink
� �� � <br /> � SASP Form <br /> cf.�t _a:r- - ° (?J 01� <br /> � i]�tY��St'�L ���yY I <br /> ��� <br /> E�'�etrc�r��rs��r��. Bt^,,v�� �r. <br /> STATE OF CALIFORNIA <br /> APPLICATION FOR ELIGIBILITY <br /> STATE�FEDERAL SURPLUS PROPERTY PROGRAM <br /> Pursuant to Federal Regulation 28 C.F.R.§§42.401 -42.415,a recipient is mandated to report to the Federal Government the <br /> racial and national orgins of all persons within your service area. You are therefore asked to supply the Office of Fleet and <br /> Asset Management with the race and national orgins of individuals you serve in your service area(it may be helpful to refer <br /> to the US Census to determine the raciai makeup of your service area at www.factfinder.census.govn. This form must be <br /> completed and retumed with the rest of the eligibility packet in order to qualify for the Federal Surplus Property Program. <br /> Your answers on this form in no way affect your eligibility; however, not retuming the form will delay the processing of <br /> your application. <br /> American Indian or ��5 Persons having origins in any of the tribal people of North America,and who maintain <br /> Alaskan Native % cultural identification through tribal affiliation or community recognition. <br /> Persons having origins in any of the original peoples of the far east,Southeast Asia, <br /> Asian/Pacific Pacific Islands,or the Indian Subcontinent This includes China,Japan,Korea,The <br /> Islander °�0 26'2 <br /> Philippines,and Samoa. <br /> Black �0 2•8 Persons having origins in any of the black racial groups of Africa. <br /> 0 <br /> Persons of Mexican,Puerto Rican,Cuban,Central or South American,or other Spanish <br /> Hispanic % 25'4 culture or origin,regardless of race. <br /> Person having origins in any of the original people of Europe,North Africa,or the <br /> White % 53.4 Middle East <br /> Other ��o (Specify) <br /> Michael J. siari Executive Dire�etor <br /> Print Name Title <br /> Signature Date ,3 �-3 <br /> OFFICE OE flEET AiJD ASSETMANA6Et1nEN7; Steo#e o#�,rfifotreru I.Stcate rsnc!Ccxra+rsaie�Servdces tR�errcy <br /> �7+�fi{crfic*rra+�Jri•te ! Sc;c:errrsecri�:C'A9�4 f9td.9'25.2�.=a?f4�d.928.9845 <br /> RESO P-2192 ��� <br /> ��`��`' <br />