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<br />EXHIBIT 4 <br />3 <br /> <br /> <br />State of California – The Natural Resources Agency <br />DEPARTMENT OF PARKS AND RECREATION Funding Sources <br /> <br /> <br />Grantee Name:_______________________________________ <br /> <br />Project Name:________________________________________ <br /> <br />PROJECTs funded by the program are not complete until all SCOPE items are complete <br />and open to the public. <br /> <br />If Specified GRANT funds will be used as part of the funding for a larger project, briefly <br />describe the scope of that larger project: <br /> <br /> <br /> <br />The total cost of the larger project that these GRANT funds will contribute to is <br />$____________ <br /> <br />Anticipated completion date: _________________ <br /> <br />List all funds that will be used: <br /> <br />Funding source Date Committed Amount <br />State of California 2022-23 Budget Act July 1, 2022 $ <br /> <br /> <br /> <br /> <br /> <br />I represent and warrant that I have fully authority to execute this Funding Sources Form <br />on behalf of the GRANTEE. I declare under penalty of perjury, under the laws of the State <br />of California, that this Funding Sources Form, and any accompanying documents, for <br />the above-mentioned grant is true and correct to the best of my knowledge. <br /> <br /> <br /> <br />AUTHORIZED REPRESENTATIVE Signature Date <br /> <br /> <br />Print Name and Title <br /> <br />NOTE: Submit a revised Funding Sources Form should funding sources be modified.