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l~g NORTH CAROLINA <br />DyPARTMEi~iT 0~' HUMAN RESOURCES <br />bivision of facial Services <br />CERTIFICATION OF PUBLIC FUNDS <br />The.Oran a Cou t r ; certifies that 2 25Q <br />agency amaunt - <br />in cash or certified public expenditures is available for the period <br />January pl 19 75 through June 30 7.9 76 <br />and that it will be used to provide ~ Health_Support ___ __ ,,,_, ~~ _ <br />• services~in Qx'ange Count xt is further certified that - <br />geographic area <br />the full. amount of funds indicated here:.n is eligible to be used as match <br />for appropriate Federal funds. <br />b <br />Date Authorized Representative <br />:Orange Coun~ty~gard o±~ rt,211~~1;,,~,~4.OS.?'s <br />- -- - .. - . . Agency <br />NORTH CAROLINA _. <br />DE:PARTP~NT OF HUMAN RESDURCES <br />Division of Social Services <br />DONATION AC,REr~NT <br />The Qra 9 Cotin+ Eioard or Cam;ssioners agrees to donate to the <br />donor <br />- Qr's3i7Qe County ~ ~`~~~ to . <br />specify DSS amount <br />be matched to the fullest extent possible with appropriate Federal funds <br />axed to be used fox Health SuppDrt' <br />service in Cra,ga County The donation as for-the . <br />geographic area <br />period Janua*_- C1 , 1°73 , through Juns ?A , a,9 70 , <br />and wi11 be made •/early ben. ^~-nin,S January Ol ~ 19 75 <br />(M,Q, etc. <br />~~~ ~Il ~lJ K_J_ L G~ <br />_ DSS Represantati.ve Donor Signature <br />- <br />i <br />~ ff ~ J~ <br /> <br />- - <br />Dat Date . <br />