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I <br />Applicz tion fort Certification <br />Page 2 <br />a <br />n Ct <br />theminority/women <br />Y contract tra <br />ct <br />5. Fo what portion of Y <br />ow ers be responsible: (Please clearly define.) <br />6. Wh n was your business formed? If incorporated, please attach <br />Articles of Incorporation and any Amendments as filed with the <br />Indiana Secretary of State and current certificate of Good <br />Standing. I partnership, attach current partnership <br />ag eement. <br />7. Wh t financial or management relationship do you have with any <br />of er business organization? <br />8. The undersigned hereby represents that (he /she) is the duly <br />a thorzed'representative.of Contractor and (he /s he) has the <br />re <br />quisite legal authority to make this application on behalf of <br />C ntractor'. <br />signed this day of 19 <br />Signed: <br />Printed -name: <br />Title: <br />STATE OF ) <br />)SS: <br />COUNTY ) <br />The above Application for Certification was subscribed and <br />sworn to before me, a Notary Public in and for said County and <br />State by (Name of.representative), <br />(Position with Contractor), of eared <br />(Name of Contractor), who personally app <br />b 6fora me on ,this day of 198 and stated <br />under the penalties for perjury that the matters set forth are true <br />and c rrect <br />C <br />iissioi <br />I+�vww..t_1 q"7 <br />i <br />I <br />Applicz tion fort Certification <br />Page 2 <br />a <br />n Ct <br />theminority/women <br />Y contract tra <br />ct <br />5. Fo what portion of Y <br />ow ers be responsible: (Please clearly define.) <br />6. Wh n was your business formed? If incorporated, please attach <br />Articles of Incorporation and any Amendments as filed with the <br />Indiana Secretary of State and current certificate of Good <br />Standing. I partnership, attach current partnership <br />ag eement. <br />7. Wh t financial or management relationship do you have with any <br />of er business organization? <br />8. The undersigned hereby represents that (he /she) is the duly <br />a thorzed'representative.of Contractor and (he /s he) has the <br />re <br />quisite legal authority to make this application on behalf of <br />C ntractor'. <br />signed this day of 19 <br />Signed: <br />Printed -name: <br />Title: <br />STATE OF ) <br />)SS: <br />COUNTY ) <br />The above Application for Certification was subscribed and <br />sworn to before me, a Notary Public in and for said County and <br />State by (Name of.representative), <br />(Position with Contractor), of eared <br />(Name of Contractor), who personally app <br />b 6fora me on ,this day of 198 and stated <br />under the penalties for perjury that the matters set forth are true <br />and c rrect <br />C <br />iissioi <br />I+�vww..t_1 q"7 <br />