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Attachment A <br />FY05 Homeland Security Grant Program <br />Application Cover Sheet for Operational Areas (Page 2 of 2) <br />Applicant (county) <br />Statement of Certification - Approval Authority Body - SHSP and LETPP Only <br />By signing below, I hereby certify that the Operational Area's application represents the Approval Authority Body's <br />consensus on the Operational Area's FY2005 Homeland Security Grant Program needs for the State Homeland <br />Security Program and Law Enforcement Terrorism Prevention Program. <br />Position/Designee Signature Printed Name <br />County Public Health Officer <br />County Fire Chief <br />Municipal Fire <br />County Sheriff <br />Chief of Police <br />Statement of Certification - County Authorized Agent - SHSP, LETPP and EMPG Only <br />Title <br />By signing below, I hereby certify I am the duly appointed Authorized Agent and have the authority to apply <br />for the FY2005 Homeland Security Grant Program, and the Operational Area's application represents the <br />needs for the State Homeland Security Program, Law Enforcement Terrorism Prevention Program, and <br />Emergency Management Performance Grant program. <br />Signature ofAuthorizedAgent <br />Title <br />Printed Name <br />Date <br />For State use ONLY <br />Application reviewed/Grant award approved by: <br />Name Date <br />Grant Performance Period: <br />OES ID # Award # <br />FY05 Homeland Security Grant Program Page 33 <br />