Laserfiche WebLink
Bicentennial Community Application <br /> <br /> (Name of Community) <br /> <br />Please list names, addresses and affiliations of the members of your Bicentennial group. If you need more space <br />to list members~ use blank sheets and attach. <br /> NAM E ADDRESS AFFILIATION <br /> <br />IT IS CERTIFIED: <br /> <br />Certification <br /> <br />THAT AS CHAIRPERSON OF THE BICENTENNIAL-GRouP, I AM AUTHORIZED <br />TO SIGN THIS CERTIFICATION, <br /> <br />THAT ALL THE ABOVE PROCEDURAL STEPS HAVE BEEN ACCOMPLISHED, <br /> <br />THAT THE UNDERSIGNED OR MY SUCCESSOR WILL FURNISH PERIODIC <br />PROGRESS REPORTS WHEN REQUESTED, <br /> <br />THAT IF APPROVED, THE NATIONAL LOGO WILL BE USED IN ACCORDANCE <br />WITH FEDERAL COMMISSION REGULATIONS, <br /> <br />SPACE <br />FOR <br />OFFICIAL <br />SEAL <br /> <br />Signature of Chairperson <br /> <br />Signature of Chief Elected Official <br /> <br /> <br />