Fillable Form Sf-424 - Application For Federal Assistance Sf-424

Form Sf-424 - Application For Federal Assistance Sf-424 - Mandatory Page 3

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APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY

17. Is The Applicant Delinquent On Any Federal Debt?

Yes

Explanation

18. By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein

are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any

resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to

criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** I Agree

** This list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific

instructions.

Authorized Representative:

Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Title:

Organizational Affiliation:

Telephone Number:

Fax Number:

Email: