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4.0 CERTIFICATION <br />By my signature below, I certify as the SCORE Grant Applicant, that all information I have <br />provided in this application is true and correct to the best of my knowledge. Further, I understand <br />that if I have knowingly provided any false or fraudulent information, any award received may be <br />withdrawn and/or subject to be repaid to Sherburne County. <br />Signature <br />Date <br />Applications shall be received by the Department prior to: <br />4:30 p.m. on January 27, 2012 <br />Sherburne County Zoning Department <br />13880 Business Center Drive <br />Elk River, MN 55330 <br />5.0) CONTACT INFORMATION <br />If you have any questions, please contact John Exner of the Sherburne County Zoning <br />Department at: john.exner@co.sherburne.mn.us OR 763-765-4466. <br />Page 5 of 5 <br />