THUS DONE AND SIGNED Sample Clauses

THUS DONE AND SIGNED at Baton Rouge, Louisiana on the day, month and year first written below.

THUS DONE AND SIGNED at Baton Rouge, Louisiana, on Click here to enter day of month, year.

THUS DONE AND SIGNED in the presence of the undersigned Notary Public and competent witnesses at , Louisiana, on this day of , 20 . WITNESSES: DIVISION OF ADMINISTRATION XXXXX X. XXXXX, LCDBG DIRECTOR NOTARY PUBLIC My Commission expires: WITNESSES: MANUFACTURING, INC. PRESIDENT NOTARY PUBLIC My Commission expires: WITNESSES: CITY OF MAYOR NOTARY PUBLIC My Commission expires: Attachment B is the Employee Survey Form Attachment C is the Employee Characteristics Record Attachment D is the Quarterly Status of Sources and Uses Attachment B COMMUNITY: COMPANY: PROGRAM YEAR: CURRENT DATE: / / Employee: LAST NAME FIRST NAME Employee: SSN (last four digits only) DATE HIRED / / Employee: JOB TITLE OR POSITION HUD Income Limits for FY PARISH The Employee’s FAMILY INCOME is: Please circle the number that corresponds to the income category and number of persons in your family. The income is determined by computing the total income of all family members for the last three months and then multiplying that number by four. 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons Employee: Racial Category: African American or Black White Alaskan Native or American Indian Asian African American or Black and White Alaskan Native or American Indian and White Alaskan Native or American Indian and Black Asian and White Native Hawaiian or Other Pacific Islander Please mark this box if the employee is of thefollowing ethnicity: ϒ Hispanic or Latino Employee: Check if applicable: ⎦ Unemployed at time of hire Note: 18 U.S.C. Sec 1001 provides that “whoever knowingly and willfully makes any materially false, fictitious, or fraudulent statement or representation;…shall be fined under this title or imprisoned not more than five years or both. Signature Attachment C Attachment D DATE OF REPORT: COMMUNITY: ASSISTED BUSINESS: TYPE OF GRANT: REPORT # PERIOD COVERING From: To: EXPENDITURES: PRIVATE: LCDBG: Current Period Only Total Previous Periods

THUS DONE AND SIGNED in Baton Rouge, Louisiana this day of January, 2024, before the undersigned Notary Public and witnesses after due reading of the whole.

THUS DONE AND SIGNED by and on behalf of CustomerFullName at Windhoek on this day of (Customer Signatory) (As Witness 1) by and on behalf of SALT at Windhoek on this day of (SALT Signatory) (As Witness 1)

THUS DONE AND SIGNED in Lafayette, Louisiana by the Parties hereto after due reading of the whole.