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State of California — The Natural Resources Agency <br />DEPARTMENT OF PARKS AND RECREATION <br />Funding Sources <br />Grantee Name: <br />Project Name: <br />PROJECTS funded by the program are not complete until all PROJECT SCOPE items are <br />complete and open to the public. <br />If Specified GRANT funds will be used as part of the funding for a larger project, briefly <br />describe the scope of that larger project: <br />The total cost of the larger project that these GRANT funds will contribute to is <br />Anticipated completion date: <br />List all funds that will be used: <br />Funding source <br />Date Committed <br />Amount <br />State of California 2021-22 Budget Act <br />July 1, 2021 <br />$ <br />I represent and warrant that I have fully authority to execute this Funding Sources Form <br />on behalf of the GRANTEE. I declare under penalty of perjury, under the laws of the State <br />of California, that this Funding Sources Form, and any accompanying documents, for <br />the above -mentioned grant is true and correct to the best of my knowledge. <br />AUTHORIZED REPRESENTATIVE Signature <br />Print Name and Title <br />Date <br />NOTE: Submit a revised Funding Sources Form should funding sources be modified. <br />14 <br />