I affirm all of the information contained herein that I have given in order to qualify for this grant is truthful, complete, and correct to the best of my knowledge. I understand that I will not be considered if any of the above information is
false. Furthermore, I understand and agree to repay any assistance that is obtained if such assistance was based on false or incomplete information submitted herein.
I understand that the Fallen Officer's Chief of Police may be contacted and asked to provide a statement of the Fallen Officer's good standing with the department.
Upon request, I agree to provide the Organization with evidence of the information, including financial documents such as bank statements, contained on this application. I understand that this application becomes the property
of the Organization when submitted.
Finally, if selected for a grant, I agree to provide the Organization with receipts and other requested documentation
supporting that the grant dollars were used for the intended purpose consistent with the grant.