Sbir/sttr Report Cover Page Page 3

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(9)
I understand that the information submitted may be given to Federal, State and local agencies for
determining violations of law and other purposes.
I certify that to the best of my knowledge (1) the statements herein (excluding scientific hypotheses
and scientific opinions) are true and complete, and (2) the text and graphics in this report as well as
any accompanying publications or other documents, unless otherwise indicated, are the original
work of the signatories or individuals working under their supervision. I understand that the willful
provision of false information or concealing a material fact in this report or any other
communication submitted to NSF is a criminal offense (U.S. Code, Title 18, Section 1001).
Authorized Company Officer Name: ___________________________________________
Title: _____________________________________________________________________
Signature:________________________________________________Date:_____________
PI Name :___________________________________________________________________
P.I. Signature:____________________________________________ Date:_____________

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