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California Department of Education Send three copies with original signatures by December 19, 1990 <br />Child Development Division To: Child Development Division <br />CD -3704 (Rev. 9/90) Attention: Lucy Rhodes <br />560 J Street, Suite 220 <br />Sacramento, CA 95814 <br />instructions for completing this form and other helpful information are included in the accompanying REPORTER <br />90-31. Read the statements, and select Statement A OR Statement B, as appropriate. The signature of an authorized <br />agent is required. <br />CERTIFICATION OF APPLICATION INFORMATION FOR FISCAL YEAR 1991-92 <br />For continued funding to provide child development services in fiscal year 1991-92, <br />I certify as the authorized agent, that all applicable state and federal statutes and <br />regulations will be observed. I also certify to the following statement. <br />[ J Statement A. The information contained in the most recent application <br />submitted to the Child Development Division is correct and complete. <br />[ xxJ Statement B. Except for the modifications indicated on the attached program <br />narrative and/or legal status change page(s), the information contained in the <br />remaining pages of our most recent application submitted to the Child <br />Development Division is correct and complete. <br />Project Number: (See enclosed Site Information sheet for correct project number.) <br />3 1 <br />6 <br />1-[H <br />1 <br />2 <br />9 <br />0 <br />0 <br />0 <br />1 3 t <br />2 <br />1 5 <br />1 2 <br />Legal Name of Agency <br />CITY OF COLTON <br />Address City Zip Code <br />650 N. LaCadena Dr. Colton CA 92324 <br />Executive Officer/Superintendent <br />Telephone <br />Robert Wynn <br />X714) 370-5086 <br />Address <br />660 Colton Avenue Colton CA 92324 <br />Program Director <br />Telephone <br />Susan Brigham <br />(714) 370-5086 <br />Address <br />660 Colton Avenue Colton CA 92324 <br />Board Chairperson <br />Telephone <br />Edmund Sotelo <br />(714) 370-5051 <br />Address <br />650 N. LaC ena Dr. Colton CA 92324 <br />SIGNATURE OF AUTHOR NT <br />DATE <br />/o <br />12-3-90 <br />Name and Titleuthorized Agent <br />Robert Wynn, Executive Officer, Director, Parks, Recreation &Hum.S <br />v <br />