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I DIN MUGS <br />Applicant share: $ 51,712 <br />Other resources: $ 500 <br />11L.M. Of <br />G. CERTIFICATION: <br />I I . <br />The applicant certifies that the information contained in this <br />application is true and correct to the best of his/her knowledge. <br />NAME OF AUTHORIZED OFFICIAL: KeoniFox <br />TITLE OF AUTHORIZED OFFICIAL: Secretary/Treasurer <br />SIGNED: DATE: August 30, 2017 <br />DEPARTMENT OF PARKS & RECREATION <br />Page 2 <br />