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r-- _ _ . <br />IApplicant ~$0 ORDER 12372 <br />' 'PROCESS? <br />; <br />,State . ~$0 <br />Program is not covered <br />7--~----- - <br />,by E.O. 12372 <br />Local <br /> <br />'Other i$0 <br />Program Income 1$0 17. IS THE APPLICANT <br />~ f ',DELINQUENT ON ANY <br />;,FEDERAL DEBT? <br />' TOTAL ~$19,331 <br />{ <br />I ~ ;N <br /> <br />18. TO THE BEST QF MY KN(yWtEt>GE Af+ID BELIEF, ALL DATA IN THIS <br />APPt,ICATTaN ARgAPP"1.ICATIOA! ARE "FRUE AND CORRECT, THE DOCUMENT <br />I HA5 BEEI4 DULY AUfiHtfliUED BY' Gt)VEiiNtNG BODY OF THE APPLTCANT <br />iAMD THE APAtICAN't' 1Nttl. CQMPLY WITH 7HE ATTACHED ASSURANCES IF <br />fHE ASSISTANCE Y5 REQUiRED. <br />r~ <br /> <br />