This government document is issued by Governor's Office of Community Initiatives for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:h4ksvunszzk&q=https://gosv.maryland.gov/wp-content/uploads/sites/29/2017/06/2017-GSA-Sample-Nomination.pdf&sa=U&ved=2ahUKEwjN06icvr7wAhXOpYsKHcZSBqg4HhAWMAN6BAgCEAI&usg=AOvVaw3zY30i64rkG6c8OcoIHO55