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Okaloosa County BOCC — December 18, 2012 — Families Count Approval Form — reading text
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APPENDIX V
Certification of Local Government Approval
For Nonprofit Organizations
1, duly authorized to act on behalf
(Name and Title)
of the OKALOOSA Cov FY , hereby approve the following
(Name of City or County Government)
emergency shelter, homeless prevention or street outreach activities proposed by
Noerdloes 7. Fiverd4 Comb Gusive SVS, located in OkALoos Cova ry
(Name of Agency) (Name of City or County)
By:
(Name) (Title)
(Signature)
(Date)
Note: U.S. Department of Housing and Urban Development regulations require non-profit
organizations to receive certification of local government approval prior to accepting an
Emergency Solutions Grant award. This approval signifies the knowledge of the
referenced program operating in the local government jurisdiction.
This form MUST BE signed, dated and returned with the solicitation in order for the
solicitation to be considered for funding.
2012 Emergency Solutions Grant Application LPZO9. «-51|Page