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E. Certification <br />I certify that Election Assistance for Individuals with Disabilities (EAID) Grant funds will be <br />used only for the polling places listed on the attached worksheet(s) and only to procure or <br />purchase: <br />• Physical accessibility improvements to polling places in Minnesota and /or, <br />• Improvements to assist individuals with disabilities to vote privately and <br />Independently, consistent with section D of this application. <br />Name of Jurisdiction: <br />0� LI 00 ta,�s <br />� <br />Printed Name of Applicant: 7J-, �d [ <br />Title of Applicant: P ( i I,r) I s--/-----ro - 6(-- <br />Signature: 1 ;)7- ® Date: 1/— c <br />All questions must be completely answered. An unanswered question could result in the <br />disqualification of the application. If a question is not applicable, please indicate. <br />All applications must include a resolution authorizing the application for these funds. <br />Submit completed application and all accompanying worksheets and documents to: <br />MN Secretary of State <br />Attention: Brad Anderson <br />180 State Office Building <br />100 Rev. Dr. Martin Luther King Jr. Blvd. <br />St. Paul, MN 55155 -1299 <br />Fax: 651- 296 -9073 <br />Or via email to: bradley.k.anderson a,state.mn.us <br />All submissions must be received by 4:00 p.m. on Wednesdays, December 4, 2013 <br />All work must be completed no later than August 9, 2014. <br />5 <br />