120-26 LEAP - Challenge Application - Supplemental Forms.pdf

Participating Local Unit Acknowledgement By signing this application form, each participating local unit signatory attests to the express authority to sign on behalf of the local government he or she represents and to the accuracy of the information contained in the application. Date: Signature (Print) Name and Title: (Print) Applicant (Lead) Entity: City of East Orange Date: Signature (Print) Name and Title: (Print) Participating Local Entity: Township of West Orange Date: Signature (Print) Name and Title: (Print) Participating Local Entity: Date: Signature (Print) Name and Title: (Print) Participating Local Entity: