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HSEM Grant No. 2008 -CCP -00630 <br />including the refusal to disburse additional funds and requiring the return of all or part of the funds <br />already disbursed. <br />0 15 Data Disclosure <br />Under Minn. Stat. § 270C.65, and other applicable law, the Grantee consents to disclosure of its social <br />security number, federal employer tax identification number, and/or Minnesota tax identification <br />number, already provided to the State, to federal and state tax agencies and state personnel involved in <br />the payment of state obligations. These identification numbers may be used in the enforcement of <br />federal and state tax laws which could result in action requiring the Grantee to file state tax returns and <br />pay delinquent state tax liabilities, if any, or pay other state liabilities. <br />1. ENCUMBRANCE VERIFICATION <br />individual certifies that funds have been encumbered as <br />required by Minn. Stat §§ 16A. 15 and 16C.05. <br />Date: <br />Grant Contract No. 2008 -CCP -00630/2000-12376 <br />2. GRANTEE <br />The Grantee cerifies that the appropriate person(s) <br />have executed the gram contract on behalf of the Grantee as <br />required by applicable articles, bylaws, resolutions, or ordinances. <br />By: <br />Title: <br />Date: <br />By: <br />Title: <br />Date: <br />3. STATE AGENCY <br />By: <br />(with delegated authority) <br />Distribution: <br />DPS/FAS <br />Grantee <br />HSEM <br />2007 Citizen Corps Program (05/08) Page 5 <br />