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Legal Status: <br /> Individual(01) Estate or Trust(10) <br /> Sole Proprietor(02) Pharmacy-Noneoporate(l 1) <br /> Partnership/Legal Corporation(03) Nonresident Alien(13) <br /> Corporation(04) Pharmacy/Funeral Home/Cemetery Corp(15) <br /> Not For Profit Corporation(04) Tax Exempt(16) <br /> Medical Corporation(06) Limited Liability Company(select applicable <br /> X Governmental(08) tax classification) <br /> C-Corporation <br /> P-Partnership <br /> GRANTEE: <br /> City of Decatur <br /> Grantee's execution of this Agreement shall serve as its certification under oath that Grantee has read,understands <br /> and agrees to all provisions of this Agreement and that the information contained in the Agreement is true and <br /> correct to the best of his/her knowledge,information and belief and that the Grantee shall be bound by the same. <br /> Grantee acknowledges that the individual executing this Agreement is authorized to act on the Grantee's behalf. <br /> Grantee farper acknowledges that the rd of Grant Funds under this Agreement is conditioned upon the above <br /> certificati <br /> By: fp ,'�0 C44 <br /> 4A—u- W!Qgn�to� Date <br /> Michael McElroy,Mayor / <br /> Name and Title 7 <br /> STATE OF ILLINOIS DEPARTMENT OF COMMERCE AND ECONOMIC OPPORTUNITY <br /> By. <br /> Adam Pollet,Director Date <br /> Grantee Address: Please indicate any address changes below <br /> 1 GARY K ANDERSON PLZ <br /> Decatur,IL 62523-1005 <br /> In processing this grant and related documentation,the Department will only accept materials signed by the <br /> Authorized Signatory or Designee of this Agreement,as designated or prescribed herein. If the Authorized <br /> Signatory chooses to assign a designee to sign or submit materials required by this Agreement to the Department, <br /> the Authorized Signatory must either send written notice to the Department indicating the name of the designee or <br /> provide notice as set forth immediately following this paragraph. Without such notice,the Department will reject <br /> any materials signed or submitted on the Grantee's behalf by anyone other than the Authorized Signatory. The <br /> Authorized Signatory must approve each Authorized Designee separately by signing as indicated below. If an <br /> Authorized Designee(s)appears below,please verify the information and indicate any changes as necessary. <br /> Page 3 Grant Number 15-203002 <br />