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Okaloosa County BOCC — July 15, 2014 — Rick O - GrantSolutions Grantee User Account Request Form — reading text
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Grantee User Account Request Form
Request Type: New Account Account Change Account Closure
Partner Agency: Department of Health and Human Services Department of State
Department of Agriculture Social Security
Department of Transportation Denali Commission
Other Treasury - RESTORE Act
Role Authority: Authorizing Official Financial Officer
Program Director/Principal Investigator Financial Officer Support
Support Staff
Organization Name: Okaloosa County
Address 1: 1804 Lewis Turner Blvd, Ste 206
Address 2:
City: Fort Walton Beach State: FL ZIP + 4: 32547-1285
Grant Number(s):
This should be a grant number of any grant awarded to your organization that is or has been in
GrantSolutions. This will be used to help confirm organization information.
First Name: Ricky Last Name: Owen
Title: RESTORE Act Coordinator
Phone: (850) 651-7515 Fax:
Email Address: rowen@co.okaloosa.fl.us
Person Address 1: 1804 Lewis Turner Blvd, Ste 400
Person Address 2:
City: Fort Walton Beach State: FL ZIP + 4: 32547-1285
Please complete the Person Address only if it is different from the Organization Address.
Authorized Official Name: Charles K. Winders, Jr.
Title: Chairman
Authorized Official Signature:
Note: Request should be signed by authorized organization business/signing official.
Version 6/2013