HomeMy WebLinkAbout20051342.tiff COLORADO DIVISION OF CRIMINAL JUSTICE(DCJ)
JUVENILE ACCOUNTABILITY BLOCK GRANT(JABG)
"INTENT TO ACCEPT FUNDS"FORM
Unit of Local Government: e L O C a c,N r V
(Please type or print name of county/municipality)
Interest/intent regarding JABG: (Please check the appropriate response)
X Interested in receiving our FY04 JABG allocation. (Complete the remaining items on this page)
Not interested in receiving our FY04 JABG allocation. Our allocation can revert to the state to benefit programs
statewide. (Skip to the name and signature of the Authorized Official)
Official Contact Person for Future Correspondence Concerning our JABG Award: (Designated by the Authorized Official.)
Name: /('L Al /da .✓ c L C o c,f Title: C 4 tJ& e,e
Agency: Al 41 c0 ci ccinN Tr rf/_.Plri-S o."-",c..4-
Address: /f
G.P Cc'C!= Y C O foG.J/
Phone:(no S Se"-?cis- ;Fax:(Pa) Jor--est- ;E-mail:/2^onee/./ (g7 Co _ �a/ec_ vs
Certification of Cash Match:
Xf I hereby certify that,upon award,a cash match of ten percent(10%)of the total program cost-Federal
award plus cash match-will be provided. If any funds are used for construction of permanent corrections facilities,we will
provide a 50%cash match.
Juvenile Crime Enforcement Coalition:
X Attached is our proposed list of members of our local Juvenile Crime Enforcement Coalition which meets the required
representation. A final list will be provided with our coordinated enforcement plan for reducing juvenile crime.
Authorized Official for this Unit of Government: [Chair of County Commissioners;Mayor, City Manager, or Chair of City
Council(provide documentation of appropriate authority)]
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED ON THIS PAGE IS CORRECT.
Name: William H. Jerke Title: Chair
Signature: 4�//�✓ Date: MAY 0 2 2005
The deadline for submission of this intent form is May 31, 2005
RETURN THIS AND ATTACHED PAGE BY MAIL OR FAX TO:
Carol Gould,Planning/Grants Specialist
Colorado Division of Criminal Justice
700 Kipling, Ste. 100,Denver,CO 80215
Fax:(303)239-4491
2005-1342
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