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__ <br />FY2004-2005 CT Application <br />FederaUState Certifications <br />Subscribed and sworn to me (date) ~2~4o2wJf GL /~ o'L4G .3 <br />4 <br />rr f,. , n.,x~:,. <br />CuQ'7.~. - I/- D o~iQ ~ ~ O ~ /U ~ Seal <br />dress 2~2? ~ <br />My commission expires (date) <br />*Note that the official authorized to submit the grant application, certifying official, and notary public should be three separate <br />individ//uals. <br />l~L~~ i~ 2 ~/~-~ O~ <br />` ~ ~ C ~-~ 2?~' <br />Section II <br />Page 10 of 19 <br />