State Programs - Legal Officers Certification Form

State: ____________________

STATE LEGAL OFFICER’S CERTIFICATION OF
AUTHORIZED CERTIFYING OFFICIAL

I hereby certify that in
__________________________________________________________
Name of State
__________________________________________________________
Name of State Agency
is the official State Agency with authority under State law to develop, submit, and
administer or supervise the administration of the State Plan under the Library Services
and Technology Act; that
__________________________________________________________
Name of Authorized Certifying Official)
is the officer authorized to submit the State Plan, sign all assurances, certifications, and
reports and to whom the grant award is made for the named State Agency; that the
State Treasurer or
___________________________________________________________
Title of Officer other than State Treasurer)

has authority under State law to receive, hold, and disburse Federal funds under the
State Plan; and that all provisions contained in the Plan are consistent with State law.
__________________________________________________________
Signature of Attorney General or Other State Legal Officer
__________________________________________________________
Print Name and Title
__________________________________________________________
Date

OMB No. 3137-0071; Expiration Date: 8/31/2013