06-B Juv. Account. Grant Waive - Laserfiche WebLink

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JUVENILE ACCOUNTABILITY C , AL Jo ,cE P.O. Box 12428 BLOCK GRANT (JABG) WAIVER 512/463-1919 oF FUNDS FORM , ww.cow,,o,.s,A,E 1 T.A.C. ~3.t21t Any entity re~iving a I~1 atio~fion may waive ~eir ~ght ~ ap~y ~r ~nds and may ch~se instead to ~ive their al[~ation ba~ to the S~te or to ano~er enfi~. The gm~ ap~i~nt ~at is r~uesting CJD ~nding is responsible for ob~ining the ~itten a~o~zafion from ea~ en~ ~at ~s to waive their allo~bon to ~e appli~n~s organiza~on. In addition, the grant appli~nt is res~sible ~r ~arding this ~gn~ d~ment at the same 5me ~at ~e GrantAppllcation Ce~fication Form is submiE~ to CJD via facsimile or mail. CJD ~ti not award any additionalwaiv~ ~nds to ~e appti~nt organi~on until ~e waiver fo~m is signed and receiv~ by CJD via ~imile or mail. PART I: WAIVER OF ALLOCATION 1. D~s the en~ ~oo~ to waive their all~tion to CJD? TM a) The Name of En~ Waivin~ Funds: b) The waived ~nds amount ($): c) The name of ~e organ~ation that will r~eive the allo~tion waived ~ by your enti~: d) If ~nds am ~ing waiv~ to mom ~an one organization, ENTER ~e addi~onal name(s) of ~e organizaBon(s) r~iving ~nds and ~e amount of ~e waiv~ ~nds: Name(s) of the Entity(les) Receiving Waived Funds Waived Funds Amount PART I1: SIGNATURE AUTHORIZING THE WAIVER OF ALLOCATION The above-named entity waiving the allocation understands that if funds ate waived to the Governor's Office, Cdminal Justice Division (C JO), that those funds may be earmarked at the discretion of the executive director. Or, if funds are waived to another entity, the above-named entity waiving funds understands that those funds may be used to provide eligible services to organizabon(s) that are eligible for their own separate granL The entity waiving funds hereby authorizes the above-named organization(s) to receive the allocated funds that were initially dedicated to our organization in effect on the date this form is signed by the authorizing official as listed below. Name of the Entity'$ Authorized Official Name of the Waiving Entity Title of the Entity's Authorized Officia~ Signature of the Enfity'$ Authorized Effective Date EXHIBIT