MIAMI-DADE COUNTY DEPARTMENT OF CULTURAL AFFAIRS
MIAMI-DADE COUNTY DEPARTMENT OF CULTURAL AFFAIRSBANK ACCOUNT DISCLOSURE FORMGRANTEE NAME:____________________________________________________________________________________DESIGNATED BANK IN WHICH GRANT FUNDS WILL BE KEPT: ____________________________________________________________________________________ADDRESS:____________________________________________________________________________________PERSON(S) AUTHORIZED TO WITHDRAW FUNDS OR TO WRITE CHECKS:Name: ______________________________________ Title: _________________________________Name: ______________________________________ Title: _________________________________Name: ______________________________________ Title: _________________________________ Submitted by:Signature: ___________________________________________________________________ Printed Name: ________________________________________________________________ Date: ______________________________ ................
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