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Grantee AC14 Authorization Form <br />A voided check may be attached to this form. <br />(CFDA Number) <br />(Address of Financial Institution) <br />Account Type: []Checking Savings <br />Financial Institution Routing Number: - � Account Number: I <br />These numbers are located on the bottom of your check as follows: <br />4. <br />;�?wlsra'I�lirttrtri�txuuylis�d'��n <br />I hereby authorize the Indiana Housing and Community Development Authority (".U:.iC DA") to. <br />— --- — 's <br />initiate entries to <br />checking/savings accounts at the lhiar�aial iristitutioii listed above, and, zirecessary, initiate <br />adjustments for any transactions credited/debited in error. This authority will remain in effect Until <br />MCDA is notified by an authorized individual in writing to cancel it in such tirnc as to afford <br />IIICDA and the financial institution a reasonable opportunity to act on it. In addition, I certify that I <br />have full authority to execute this authorization and grant the rights to ITICDA contained herein. <br />(Signature) <br />(Date) <br />ADDRESS 30 South Meridian Street, Suite 1000, Iridianapolis, IN 46204 <br />PHONE 317 232 7777 TOLL FREE 800 872 0371 VVES www.ihrda.IN.gov SW1enFFndlana � � <br />Lieutenant Governor 1 <br />suzansie Crouch j <br />EQUAL OPPORTUNITY EMPLOYER AND HOUSING AGENCY <br />