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. J <br /> • Attachment 1 <br /> Page 2 of 8 <br /> Pizon T INFORMATION SHEET <br /> JA,pplication Agency(with which contract is to be executed) - <br /> Legal Name Street-City-Zip Phone <br /> 3301 Silver Lake Road <br /> St. Anthony Police Deft. St. Anthony, MN 55418 ( 612 ) 789-5015 <br /> 2Authorized Official <br /> Legal Name Street-City-Zip Phone <br /> 3301 Silver Lake Road <br /> Chief Richard Engstrcim St. Anthony, MN 55418 ( 612 ) 789-5015 <br /> 3.0perating Agency (if different from #1) <br /> Legal Name Street-City-Zip Phone <br /> 4.Contact Person for further information on application -- - <br /> Legal Name Street-City - Zip Phone <br /> 3301 Silver Lake Road <br /> Lt. John Ohl St. Anthony, MN 55418 (612 ) 789-5015 <br /> 5. I certify that the information contained herein is true and accurate to the best of my knowledge <br /> and that I sL-bmic this application on behalf of the applicant agency. <br /> Signature of;,uthiorized Official�c1x��� <br /> True <br />