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Certification <br /> <br /> I certify that Election Assistance to Individuals with Disabilities (SAID) Grant <br /> funds will be used only for the polling places listed on the attached worksheet(s) <br /> and only to purchase and install automatic doors for polling places in Minnesota. <br /> Name of Jurisdiction: <br /> Printed Name of Applicant: <br /> Title of Applicant: <br /> Signature: Date: <br /> All questions must be completely answered and a resolution of support from the <br /> governing body must be provided. An unanswered question or lack of a resolution <br /> could result in the disqualification of the application. <br /> All information must be submitted in writing as part of this application. If a <br /> question is not applicable, please indicate. <br /> Forward completed applications via email to elections.de~~state.mn_us, <br /> Attention: Adam Aanerud. <br /> If necessary, fax or mail completed application and all accompanying worksheets <br /> and documents to: <br /> MN Secretary of State <br /> Attention: Adam Aanerud <br /> 180 State Office Building <br /> 100 Rev. Dr. Maz•tin Luther King Jr. Blvd. <br /> St. Paul, MN 55155-1299 <br /> Fax: 651-296-9073 <br /> All submissions must be received by 4:00 p.m. on Friday, March 19, 2010. <br /> All work must be completed no later than August 6, 2010. <br /> 5 <br /> 7 <br /> <br />