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The undersigned applicant authorizes the Town / County to obtain credit information for the <br />purpose of evaluating this application and to obtain verification of any of the information) <br />contained in this application from any source named herein. <br />The undersigned applicant agrees to at all times indemnify and hold harmless the Town / County'' <br />against all losses, costs, damages, expenses and liabilities of any nature or kind (including, but <br />not limited to attorney's fees, litigation and court costs, amounts paid in settlement, amounts paid <br />to discharge ,judgment, and any loss from ,judgment) arising out of, or related to acceptance, <br />consideration, approval or disapproval of this application. <br />The undersigned applicant hereby certifies that the project proposed in this application can be <br />developed in accordance with the development budget set forth herein and operated in <br />accordance with the operating budget set forth herein. <br />IN WITNESS WHEREOF, the undersigned, being duly authorized, has caused this document to <br />be executed in its name on this day of , 2004. <br />(Legal Name of Applicant) <br />By: By: <br />(Signature — Chair of Board) <br />UZ <br />(Print Name) <br />CDBG / HOME Program Application 12 <br />.January 2004 <br />(Signature— Executive Director) <br />(Print Name) <br />21 <br />