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California State Library <br />Fiscal Office <br />P.O. 942837 <br />Sacramento, CA 94237-0001 <br />LSTA GA CERTIFICATION <br />LSTA GRANT AWARD # 40-8039 <br />Project Title: Santa Ana Youth Overcoming Obstacles, One Discussion at a Time <br />System/Agency: Santa Ana Public Library <br />PLEASE COMPLETE AND RETURN THIS PAGE <br />CERTIFICATION <br />I affirm that the subgrantee named below is the legally designated representative for this <br />program and is authorized to receive and expend funds for the conduct of this program. <br />I certify that all information provided to the California State Library for review in association <br />with this award is correct and complete to the best of my knowledge; that as the <br />authorized representative of the subgrantee, I have the legal authority to commit my <br />organization to the conditions of this award. <br />III. 1 certify that any or all other subgrantees participating in the program have agreed to the <br />terms of the application/grant award, and have entered into an agreement(s) concerning <br />the final disposition of equipment, facilities, and materials purchased for this program from <br />the funds awarded for the activities and services described in the attached, as approved <br />and/or as amended in the application. <br />SIGNED <br />Authorized <br /> <br />sentative <br />DATE a <br />f_G -S ?'`I V I C? <br />Type or print name and title of authorized representative <br />Legal name of local subgrantee <br />Project name as listed on the application <br />L L? (' C; t? k 'N V <br />address of named subgrantee <br />city <br />?7 E4> lfLVI <br />County Zip Code Telephone of authorized rep. <br />Coordinator/Director of program, if different <br />Type or print name and title <br />tive <br /> <br />WHO SHOULD RECEIVE INSTRUCTIONS FOR PREPARING REQUIRED <br />(Provide name, address and telephone number. Use back, if needed) <br />C7 ) Lq1-S-3S4 <br />Telephone <br />RTS: