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HomeMy WebLinkAboutContract 42937 (2)�i t�f SECRETAI� / .' G� C�M�,Vf� O��s � � /'� '�.. OFFICE OF TH� GOVERNOR .IUVENILE ACCOUNTABILITY CRIMINALJUSTICEDIVISION P.O. Bo112428 BLOCK GRANT (.1ABG WAIVER AUST�N,TE�,s�s��� OF FUNDS FORM 512/463-1919 FaY: 512/475-2440 �i'�V�V.GOVERNOR.STATE.T<l'.US 1 T.A.C. §3.1211 Any entity receiving a local allocation may waive their ability to apply for funds and choose instead to waive the allocation to a larger or neighboring city, county, or Native American tribe that will still benefit the waiving entity's area. To designate an agency to receive your jurisdiction's allocation, complete this form and fax it to (512) 475-2440 by the application submission deadline. The applicant that is requesting CJD funding is responsible for obtaining written authorization from each agency that chooses to waive their allocation. CJD will not award any additional waived funds to the applicant organization until the waiver form is signed and received by CJD. Funds will revert back to CJD if not requested or waived by the application submission deadline. PART I: WAIVER OF ALLOCATION Name of agency waiving funds: City of Fort Worth Amount of waived funds: $25,258.00 The name of the agency that will receive the waived Tarrant County Juvenile Services allocation: If funds are being waived to more than one agency, ENTER the additional name(s) of the agency(ies) receiving funds and the amount of the waived funds to each agency: Name(s) of the Agency(ies) Receiving Waived Funds Amount of Funds Waived $ $ $ $ $ $ $ $ $ PART II: SIGNATURE AUTHORIZING THE WAIVER OF ALLOCATIONS The agency waiving funds hereby authorizes the above-named organization(s) to receive the allocated funds. Manaqer r, ��` > � Authorized Official r' �� � �z��'i �c/a� �i- of the Agency Waiving Funds Z —23 —/Z Effective Date �FFI�IAL R�C4RD ;lTY �ECREiARY �,� :,:;. =,;te _._„�. JABG WAIVER OF FUNDS FORM 1 ISSUE DATE: DECEMBER 2008 Charles W. Daniels Assistant City Name of the Agency's Authorized Official Title of the Agenc� , F �� , 1 �I .1UVENILE ACCOUNTABILITY BLOCK GRANT (.1ABG) WAIVER OF FUNDS FORM OFFICE OF THE GOVERNOR CRID4INAL JUSTICE DIVISION P.O. Bo� 12428 AUSTIN� TE.l'AS %H%11 512/463-1919 Fnx: 512/475-2440 �V�V�V.GOVERNOR.STATE.T%.US , ) 1 T.A.C. §3.1211 Any entity receiving a local allocation may waive their ability to apply for funds and choose instead to waive the allocation to a larger or neighboring city, county, or Native American tribe that will still benefit the waiving entity's area. To designate an agency to receive your jurisdiction's allocation, complete this form and fax it to (512) 475-2440 by the application submission deadline. The applicant that is requesting CJD funding is responsible for obtaining written authorization from each agency that chooses to waive their allocation. CJD will not award any additional waived funds to the applicant organization until the waiver form is signed and received by CJD. Funds will revert back to CJD if not requested or waived by the application submission deadline. PART I: WAIVER OF ALLOCATION Name of agency waiving funds: City of Fort Worth Amount of waived funds: $25,258.00 The name of the agency that will receive the waived Tarrant County Juvenile Services allocation: If funds are being waived to more than one agency, ENTER the additional name(s) of the agency(ies) receiving funds and the amount of the waived funds to each agency: Name(s) of the Agency(ies) Receiving Waived Funds Amount of Funds Waived $ $ $ $ $ $ $ $ $ PART II: SIGNATURE AUTHORIZING THE WAIVER OF ALLOCATIONS The agency waiving funds hereby authorizes the above-named organization(s) to receive the allocated funds. Charles W. Daniels Name of the Agency's Authorized Official Signature of the Agenc s Authorized Official bY°��----� J r �::., _., Assistant City P Title of the Agency's �. -. - � , a� . . • �" ;� _ ' . . w cy Waiving Funds � �i � JABG WAIVER OF FUNDS FORM PAGE 1 �� u D2. Z$. /2 Effective Date ISSUE DATE: DECEMBER 2008