Form DOS-1256 "Community Services Block Grant Authorized Signatures" - New York

What Is Form DOS-1256?

This is a legal form that was released by the New York State Department of State - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

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Download a printable version of Form DOS-1256 by clicking the link below or browse more documents and templates provided by the New York State Department of State.

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Download Form DOS-1256 "Community Services Block Grant Authorized Signatures" - New York

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COMMUNITY SERVICES BLOCK GRANT 
AUTHORIZED SIGNATURES 
Grantee: 
Date: 
The board of directors of the above­stated agency has authorized the following person(s) to sign CSBG contracts and 
related documents as indicated below. 
DOCUMENT 
TITLE 
NAME 
SIGNATURE 
Contracts/Amendments 
1) 
2) 
1) 
CEO/Executive Director 
Financial Reports 
2) 
Fiscal Officer/Controller 
1) 
Program Reports 
2) 
1) 
Vouchers 
2) 
The above authorizations were approved by the board of directors on 
(Date) 
Name of Board Chairperson 
Signature 
(Board Chairperson) 
(Date) 
If more than two persons are authorized to sign, copy and attach additional sheets. 
Check here if extra sheets are attached [  ]. 
FAILURE TO SUBMIT THIS FORM WITH ORIGINAL SIGNATURES INDICATES THAT ONLY THE 
BOARD CHAIRPERSON IS AUTHORIZED TO SIGN ALL CSBG DOCUMENTS. 
IF CHANGES OCCUR DURING THE CONTRACT PERIOD, A REVISED 
AUTHORIZED SIGNATURES FORM MUST BE SUBMITTED.
COMMUNITY SERVICES BLOCK GRANT 
AUTHORIZED SIGNATURES 
Grantee: 
Date: 
The board of directors of the above­stated agency has authorized the following person(s) to sign CSBG contracts and 
related documents as indicated below. 
DOCUMENT 
TITLE 
NAME 
SIGNATURE 
Contracts/Amendments 
1) 
2) 
1) 
CEO/Executive Director 
Financial Reports 
2) 
Fiscal Officer/Controller 
1) 
Program Reports 
2) 
1) 
Vouchers 
2) 
The above authorizations were approved by the board of directors on 
(Date) 
Name of Board Chairperson 
Signature 
(Board Chairperson) 
(Date) 
If more than two persons are authorized to sign, copy and attach additional sheets. 
Check here if extra sheets are attached [  ]. 
FAILURE TO SUBMIT THIS FORM WITH ORIGINAL SIGNATURES INDICATES THAT ONLY THE 
BOARD CHAIRPERSON IS AUTHORIZED TO SIGN ALL CSBG DOCUMENTS. 
IF CHANGES OCCUR DURING THE CONTRACT PERIOD, A REVISED 
AUTHORIZED SIGNATURES FORM MUST BE SUBMITTED.