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Federal Register/Vol. 68, No. 199/Wednesday, October 15, 2003/Notices 59471 <br /> AppiicantlRecipient U.S.Department of Housing OMB Approval No.2510-0011(exp.08l31/2003) <br /> and Urban Development <br /> Disclosure/Update Report . <br /> Instructions. (See Pubiic Reporting Stateme�t and Privacy Act Statement and detailed instructions on page 2.) <br /> A IicanUReci ient Information Indieate whather this is an IniUal R�port� or a�Updab Report❑ <br /> 1. Appli�antlRecipient Name,Address,and Phone(indude area code): � 2. Social Seeurity Number or <br /> , City of Decatur EmpbyerlDNumber. <br /> 217-424-2795 D�1 Gary K.. Anderson Plaza ' ' <br /> 3. HUO Program Name 4. Amount oi HUD Assisiance <br /> HOME Competitive Reallocation of Funds for Permanent RequestedlReeeived <br /> Housin for the Chroni a 1 <br /> 5. SWte tha name and beation(sUeet address,Cily and State)of the projed ar activily: <br /> City of Decatur, Illinois <br /> � Part I Threshold Deterrninations <br /> t.Are you applying for assistanee for a specifie projeci or activity7 These 2 Have you received or do you expect to receive assistance within the <br /> tertns do not indude fortnula grants,such as public housing operaUng jurisdktian of the Department(HUD),involving the projed o�activity in <br /> wbs(dy or COBG blodc grants. (For further infortnation see 24 CFR See, this application,in excess of 5200,000 during this fiseal year(Oct 1- <br /> 4.3). Sep.30)7 For further infortnation,see 24 CFR Sea 4.9 <br /> �Yes � No �Yea � No. <br /> If you answered'No"to either question 1 or 2,Stop! You do not need to complete the remainder of this form. <br /> However,you must sign the certification at the end of the report. <br /> Part II Other Governme�t Assistance Provided or Requested/Expected Sources and Use of Funds. <br /> Such assistance includes,but is not limited to,any grant,loan,subsidy,guarantee,insurance,payment,credit,or tax benefiL <br /> DepartmenNState/local Ageney Name and Address Type o(Assistance Amount Expected Uses of the Funds <br /> R uested/Provided <br /> (Note: Use Additional pages iF neeessary.) <br /> Part III Interested Parties. You must disGose: <br /> 1.All devebpers,contraeWrs,or eonsultanb invoNed in the applicafion for the assistance or in the planning,development,or implementation ot the <br /> projeCt or adivity and <br /> 2.any athar penon who has a finaneial interest in fhe projed a adivity for whieh the assistanee is souqht that exceeds 550,000 or 10 pereent of fhe <br /> assistanee(whiehever is bwe�)- <br /> Alphabetkal fist of aU persons with a reporhble Rnancial interest Soeial Security No. Type ot Parbcipatlon in Financial Interest i� <br /> in the ro or a ' For individuals, ive the last name ftrst or Em I ee 10 No. Pro' Pro' Ac ' $and Y. I <br /> Fred W. Spannaus 329-42-790 consultant $500 (0.1�) I <br /> (Notr. Use Additlonal pages if necessary.) II <br /> Certification � <br /> Waminy: If you knowingy make a falss stateme�t on this form,you may be subject to dv�7 ar ciminal panaltles under Seetlon 1001 of Tttle t8 of the I� <br /> . United States Code. In addHion.arry person who knowingly and materia0y violates arry reQuired dbdosures p(in(ormaUp�.(ncluding inle�tlonal non- <br /> disdosuro.is subjeU to eiv8 money penally rwt to exesad 510.000 for sach violadon. <br /> I eertify that Nis intortnaVon is we and com ta. <br /> Signaluro: Date: (mMad/YriY) <br /> x 12/15/03 <br /> Steve Garma City Manager I� <br /> Fortn HUD-2880(3/99) <br />