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y ..y F M <br />NORTH CAROLINA <br />IIEPARTMFSIT OF HUMAN RESOIIRCES- <br />Ilivisian of Social Services <br />,DONATION ACiREEI~NT <br />The Ora e.Coun ,agrees to donate to 'the <br />donor <br />Ora a Count $2 250 to <br />specify DSS amount <br />be matched to the fullest extent possible with appropriate Federal funds <br />and to be used far HealtlL ~ ~ - <br />service in Ora C n The donation is far the <br />geographic area <br />period Janua _1~17ri through June 30 ,~, X9~_, <br />and will be made earl beginning , 19 3~. <br />(H~Q, etc. <br />DSS Representative Donor Signature <br />Date Date <br />DSS_1319 (9-75) <br />Contract Services <br /> <br />