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APPENDIX V
Certification of Local Government Approval
For Nonprofit Organizations
L, duly authorized to act on behalf
(Name and Title)
of the Okaloosa County , hereby approve the
following (Name of City or County Government)
emergency shelter, homeless prevention or street outreach activities proposed by
Catholic Charities of Northwest Florida, Fort Walton Beach Regional Office, , located in
Okaloosa County
(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 focal 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 LPZ09. «4551 | Page