READ ALONGSIDE THE SOURCE
Okaloosa County BOCC — July 15, 2014 — Marcella E - GrantSolutions Grantee User Account Request Form — reading text
Part 1 of 1. These parts divide the reading text for browsing; they are not the source document's page numbers.
Machine-extracted text — 28-Marcella E - GrantSolutions Grantee User Account Request Form.pdf
Machine-extracted OCR text · Review label: Machine produced / unreviewed
Compare this copy with the preserved source. Review labels describe the recorded status of this file; they do not guarantee that the text is error-free. Spacing and line breaks are retained, with long lines wrapped to fit the screen.
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: Marcella B. Last Name: Eubanks
Title: Contracts & Grants Manager
Phone: (850) 651-7200 ext 4381 Fax: (850) 609-5029
Email Address: meubanks@clerkofcourts.cc
Person Address 1:
Person Address 2:
City: State: ZIP + 4:
Please complete the Person Address only if it is different from the Organization Address.
Authorized Official Name: Charles K. Windes, Jr.
Title: Chairman
Authorized Official Signature:
Note: Request should be signed by authorized organization business/signing official.
Version 6/2013