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Final Report Signoff
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Final Report Signoff
Sponsoring Institution:
Project Number:
Town Of Southold
0580 -11 -1083
I hereby certify that all expenditures reported in the Final Expenditure Report (FS-10-F) are directly attributable to
this project, and that the Final Project Narrative that has been entered is an accurate and complete account of the
project. ~'~ ~
Signed! /~' ~ ~~.~ ~~r
ChiefAdministrativeOfficer ~[!ntName: $co~t A~. Russell, $upervis0r.0f the T0wn of Southold
Instructions
The LGRMIF Grant Program Final Signoff Form must be printed and signed at the conclusion of your project. Then scan the
signed form and upload the form to your application as an attachment. Attach the form as a documant/attachment to your grant
application. Please put "Final Signoff' as the description for your attachment.
*For applicants who do not have access to a scanner, please fax the document to (518) 486-1647 or mail it to:
New York State Archives
Grants Administration Unit
9A81 Cultural Education Center,
Albany, NY 12230
View PDF version of Final Signoff Form
Cultural Education Center, Albany, New York 12230. Phone: (518) 474-6926
https://eservices.nysed.gov/ldgrants/lgApplicant.do?i=finalauth 7/5/2011