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Applicant <br />State <br />Local <br />Other <br />Program Income <br />TOTAL _ <br />;$0 <br />STATE EXECUTIVE <br />ORDER 12372 PROCESS? <br />$0 <br />$0 <br />Program is not covered by <br />E.O. 12372 <br />$0 <br />$0 <br />17. IS THE APPLICANT <br />'DELINQUENT ON ANY <br />$24,140 <br />FEDERAL DEBT? <br />N <br />_ _ , _ _ _ _ <br />18. TO THE BEST OF 1vfY KNQWLED►GE AND BELIEF, ALL DATA IN THIS <br />APPLICATIQN PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS <br />BEEN DULY AiJTHORIZED BY GQVERNING BODY QF THE APPLICANT AND THE <br />APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE <br />ASSISTANCE IS REQUI RED. <br />