1991 RES R-43-91 - Laserfiche WebLink

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-California D ient of Education Child Development Division CD -3704 (Rev. 9/'90) Send three copies with original signatures by December 19, 1990 To: Child Development Division Attention: Lucy Rhodes 560 J Street, Suite 220 Sacramento, CA 95814 Instructions for completing this form and other helpful information are included in the accompanying REPORTER 90-31. Read the statements, and select Statement A OR Statement B, as appropriate. The signature of an authorized agent is required. CERTIFICATION OF APPLICATION INFORMATION FOR FISCAL YEAR 1991-92 For continued funding to provide child development services in fiscal.year 1991-92, I certify as the authorized agent, that all applicable state and federal statutes and regulations will be observed. I also certify to the following statement. xx ] Statement A. The information contained in the most recent application submitted to the Child Development Division is correct and complete. [ ] Statement B. Except for the modifications indicated on the attached program narrative and/or legal status change page(s), the information contained in the remaining pages of our most recent application submitted to the Child Development Division is correct and complete. Project Number: (See enclosed Site Information sheet for correct project number.) 3 6 _ H 1 2 9-11=0 0 0 0 3 1 8 1 3 1:4 LegalName of Agency CITY OF COLTON Address I City Zip Code 650 N. LaCadena Dr. Colton CA 92324 Executive Officer/Superintendent Telephone Robert Wynn (714)370-5056 Address 660 Colton Avenue Colton' CA 92324 Program Director Susan Brigham Telephone (714) 370-5086 Address 660 Colton Avenue Colton CA 92324 Board Chairperson Edmund Sotelo Telephone F14) 370-5051 Address 650 N. LaCadena Dr. Colton CA 92324 SIGNATURE OF AUTHORIZED A T DATE 12-3-90 Name and Title of Authorized Agent Robert Wynn,'Executive Officer, Director,Parks,+Recreation & Hum.Svc i