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5 <br />STATE HISTORIC PRESERVATION OFFICE <br />CERTIFICATION OF MATCHING SHARE FORM <br />for <br />HISTORIC PRESERVATION FUND GRANTS <br />PROJECT: <br />GRANTEE: <br />CERTIFYING OFFICIAL /TITLE: <br />ADDRESS /PHONE: <br />CERTIFICATION STATEMENT: <br />As the official representative of the GRANTEE listed <br />above, I certify that the required nonfederal funds, <br />consisting of $ in cash, and (if applicable) <br />$ of in -kind services, are available to match <br />the Historic Preservation Fund grant which is reserved <br />for the project noted above. <br />I further certify that this matching share has not been <br />designated for any other purpose. <br />I understand that all costs charged to the grant <br />project will be in payment of budget items approved by <br />the State Historic Preservation Office, and which occur <br />during the project period. An adequate financial <br />management system (and audit procedure when deemed <br />applicable) will be maintained which provides efficient <br />and effective accountability and control of all <br />property, funds and assets <br />Notice to non - governmental grantees: please attach a <br />statement of deposit from a local bank (prepared on <br />bank letterhead) verifying that funds are available. <br />Signed: <br />Date: <br />