COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM Authorized Signature Card for Request for Funds CDBG Grant Number: Grantee Name: Issued By: California Dept. of Housing and Community Development 2020 West El Camino Avenue, Suite 500 (95833) P. O. Box 952054 Sacramento, CA (1) Typed Name of Signer, Signature and (2) Name of Signer, Signature and Title: Title: (3) Typed Name of Signer, Signature and (4) Typed Name of Signer, Signature and Title: Title: I certify that the signatures above are of the individuals authorized to request payment of funds under the grant cited above. or Printed Name of Authorizing Official (Grantee) ______________________________________ ______________________________________ Signature of Authorizing Official (Grantee)* Date Instructions Funds requests require two signatures--the preparer and any one of the authorized signers listed on the signature card. The name and/or title of the authorizing official must be identified in the resolution passed by the city council or governing body. The resolution must be submitted along with the signature card. The authorizing official is certifying that persons listed on the signature card are authorized to sign the funds request. A signature card must be completed for each grant. A new signature card must be submitted when there is a change in the name and/or title of the authorizing official. No erasures or corrections may appear on this signature card.
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM Authorized Signature Card for Request for Funds CDBG Grant Number: Grantee Name: Issued By: California Dept. of Housing and Community Development 2020 West El Camino Avenue, Suite 500 (95833) P. O. Box 952054 Sacramento, CA (1) Typed Name of Signer, Signature and Title: (2) Name of Signer, Signature and Title: (3) Typed Name of Signer, Signature and Title: (4) Typed Name of Signer, Signature and Title: I certify that the signatures above are of the individuals authorized to request payment of funds under the grant cited above. or Printed Name of Authorizing Official (Grantee) ______________________________________ Signature of Authorizing Official (Grantee)* ______________________________________ Date Instructions Funds requests require two signatures--the preparer and any one of the authorized signers listed on the signature card. The name and/or title of the authorizing official must be identified in the resolution passed by the city council or governing body. The resolution must be submitted along with the signature card. The authorizing official is certifying that persons listed on the signature card are authorized to sign the funds request. A signature card must be completed for each grant. A new signature card must be submitted when there is a change in the name and/or title of the authorizing official. No erasures or corrections may appear on this signature card.
cdbg_signature_card_revised_10282013.docx