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HSEM Grant No. 2007-CCP-00480 <br />will. not be fulfilled. The State may take action to protect the interests of the State of Minnesota, <br />including the refiisal to disburse additional funds and requiring the return of all or part of the funds <br />already disbursed. <br />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 errzployer tax identification number, and/or Minnesota tax identification. <br />num. ber, 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 cerlifaes that funds have been encumbered as <br />required by Minn. Stat. §§ 16,9.15 and I tiC.05. <br />Signed: _.. <br />Date: ~ __ ... _... <br />Grant Contract No. 2007-CCP-00480 / 2000-11618 <br />2. CKANTEE <br />The Grantee cer°tiftes that the appropriate person(s) <br />have executed the grant contract nn behalf of the Grantee as <br />required by applicable articles, bylaws, resolutions, or ordinances. <br />Date: __ .. <br />By: _ ._ <br />Date: __ ~_ <br />3. STATE AGENCY <br />By: _ <br />(with delegated authority) <br />Title: <br />Date: <br />Distribution: <br />DAS/FAS <br />Grantee <br />HSI;M <br />• <br />2005 Citizen Corps Program (12/06) Page 5 <br />