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12 <br /> SIGNATORY FORM AND CERTIFICATION Grant No. <br /> Recipient Name <br /> Address: <br /> Signatures of individuals authorized to sign Requisition for Funds forms.(Two signatures required on each requisition.) <br /> c <br /> f <br /> (Signature) (Typed Name) (typed Title) <br /> (Signature) (Typed Name) (Typed Title) <br /> (Signature) (Typed Name) (Typed Title) <br /> (Signature) (Typed Name) (Typed Title) <br /> CERTIFICATION <br /> 1. ( ) 1 certify that the signatures above are of the individuals authorized to sign Requisition for Funds form for the <br /> above recipient. <br /> i <br /> Certifying Official + Title <br /> 2. ( ) The governing board has passed a resolution authorizing the persons above to sign Requisition for Funds forms <br /> for the above recipient. A copy of the resolution is.attached. <br /> 1 certify that the signatures above are those of the individuals authorized by resolution of the governing board <br /> of the recipient to sign Requisition for Funds forms. <br /> Certifving Official + Title <br />