HomeMy WebLinkAboutC2005-092 - 3/29/2005 - ApprovedJUVENILE ACCOUNTABILITY
BLOCK GRANT (JABG) WAIVER
OF FUNDS FORM
OFFICE OF THE GOVERNOR
CRIMINAL JUSTICE DIVISION
P.O. BOx 12428
AUS'I1N, TEXAS 78711
512/463-1919
FAX: 512/475-2440
WWW.GOV£RNOR.STAT£.TX.US
I T.A.C. §3.1211
Any agency receiving a local atiocation ma'/waive their abi[ity to appbj for hands and choose instead to
waive tho alDcafion back to the Governor's Cdminal Justice Division or one or more agencies 0~at may still
benefit the waiving agency's area. The applicant that is requesting CJD funding is responsible for obtaining
tho wdttan authorization from each agency that chooses to waive an allocation. In addition, tho applicant Is
responsible for forwarding this signed document to CJD via facaimile by March 15, 2005. CJD will not award
any additionalwaived funds to the applicant organization unl~l the waiver form is signed and received by
CJD.
PART h WAIVER OF ALLOCATION
1. Does the agency choose to waive its allocation Io CJD? II Yes
2. Does the agency choose to waive its allocation to another [] Yes
agency?
_3. If you selected 'Yes', [or either # I or # 2 above, PROVIDE the fotiov~ag information:
a) The name of agency waiving funds: I
b) The amount of waived funds:
c) Tho name of tho agency that will receive tho waived I
allocation.
d) If funds are being waived to more than one agency, ENTER the additional
receiving funds and tho amount of tho waived funds:
Name(s) of the Agency(les) Receiving Waived Funds
No
No
name{s) of the agency(ies)
Amount of Funds Waived
$
$
$
$
$
$
$
$
$
PART I1: SIGNATURE AUTHORIZING THE WAIVER OF ALLOCATION
The above-named agency waiving the allocatioo undemtands that if funds are waived to the Governor's
O~ce, Criminal JusUce Division (CJD), that those funds may be earmarked at the discretion of the executive
director of the Criminal Justice Division. Or, if hands are waived to another agency, the above-named
agency waiving funds understands that those funds may be used to provide juvenile accountability-based
services to Ule waMng agency's target area.
The agency waiving funds hereby authorizes the above-named organizatlon(~
allocated funds.
Name of ~her~,gency s ,~u~orizod
CJD
Name of [he WaMng Agency
~~c'y's Authodzed
'FI0e of the J~,gency's Aut~odz~l Official
2005-092
03/29/05
Res026182