Colorado Heritage Planning Grants Program Application (Page 5 of 5) in pdf

Colorado Heritage Planning Grants Program Application Page 5

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To the best of my knowledge and belief, statements and data in this application, including the required

Applicant Statement of Assurances and Certifications and the attached tables and other

documentation, are true and correct and its submission has been duly authorized by the governing

body of the applicant/lead jurisdiction and other participating jurisdictions.

Signature, Chief Elected Official

Signature, Chief Elected Official*

Name (typed or printed)

Title

Date

*Additional signatures are required for “multi-jurisdictional” applications. The Chief Elected Official of each local government

participating in the application must sign.

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Please submit one original and five copies to:

Department of Local Affairs

Office of Smart Growth

1313 Sherman Street, Room 521

Denver, Colorado 80203

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Attachments List (check and submit if applicable; one set per application):

Colorado Heritage Planning Grant Program

October 2000

A-5

Colorado Heritage Planning Grants Program Application Page 5