Form Naa-01 - Connecticut Neighborhood Assistance Act (Naa) Program Proposal - 2004 Page 4
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PART IV — MUNICIPAL INFORMATION
To be completed by the municipal agency overseeing implementation of the program
Name of Municipal Agency Overseeing Implementation of the Program:
Mailing address:
Name of Municipal Liaison:
Telephone Number:
Fax Number:
E-mail address:
Post-Project Review
Is a post-project review required for this proposal?
Yes
No
If “Yes,” date post-project review due:
Date
Form NAA-01 (Rev. 3/04)
Page 4 of 4
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