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<br />Street <br /> <br />City <br /> <br />State <br /> <br />Zip <br /> <br />Action <br /> <br />If your place of perfonnance is different from the physical address provided by you in the Applicant Information, <br />click on Add Place of Perfonnance button above to ensure that the correct place of performance has been <br />specified, You can add multiple addresses by repeating this process multiple times, <br /> <br />Section 17.630 of the regulations provide that a grantee that is a State may elect to make one certification in each Federal <br />fiscal year. A copy of which should be included with each apptication for DHS funding. States and State agencies may <br />elect to use a Statewide certification. <br /> <br />Signed by Eddie Fitzgerald on 03/04/2004 <br />