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34 <br />SiJFPf_EMEJ~I7AL fNFC?RI~PA7f~N R~QUJRF~ Ff?f2 NC (7P~'NBC}OK <br />INSTRlJCT1C?W5: (:ompl.^.tg ;ne i~ifuren2li~,r~ CCI•~?u end r.^.turn it ~~ the Con[~Ct Adniin;strator idenli~ied in yvurOri~irdl u0~'dr~,ut. <br />This inf<~rni~[:r.~„ must if: suhrnittcd as part of your cc~n.'at•t_ .tyc•,u have GuestiGrts, ple8sp Cnntar.:th~ ContractPtidminislydl::r ~ <br />cr lNa Altrrn~ta Contact as refle:aeCl in yn.n• can:rect. <br />PUf;PCSSE: to January 21;}043, Ex(?[:LJtI'l~ Orr12' ~ 1$"dS Slgnfs~ by ftse GOV2r11Or 4` North Cs:rnlina. phis <br />Executive Order requrc;s [:eritiiii 'u'ifo'i:•.ation Le col:~c~eci :ra-n Grantees to enharlCr accniintAl~ility 811CI <br />t~nsparency of State Funds. Ti~eretore, the it ~.°orrYma:ion outlined below shrell'~E su~initted prior t4 tl;e <br />disbursenie-~t of any State tl.~nd~ by t:-ir. Nr~riF• ~arol~nz Depert^":cnt of ~',gr3culture and Ccns.ImEr Scrv`.ccs. <br />Curtra^t Nurnher: __• _ •_• _.•_ __ Ai~ient!i7unt Nurnb~-r: <br />Lrantee N•:.ni~: __ __ <br />17t1N8 hurn",cr: __-_ -_• ISEa atr~ hatl I•i'uir:~ttion ci: hew tc secrcz a nunher~ <br />'`+4h ID Number: _ ._.. . _ <br />Fiscal Year ~ncis: <br />1. BreF aeSCril~t~~ii anr. 3ac'-grrounL?His:~ry L _ 1r,:~r ~7!g ,n~z~tian. <br />Bs s.,~o',c InGaCa th~ nurrher ~~t year it exishnCi:. 96 ml:gr of pmt:I::y~ES; missiun ~:C{t guuls o` gpur :,rr.~-ii~at m. -T __ <br />2. Curren p+i~jeia t~ ~eliix:. G~:gin • . _..__ F.nd _._. • •-- <br />s ~xpc•.•eti:~d ~tcomes a:ul s;.eciic deI ar:~i~lA;. <br />-- I?Y:?F.CT= . a_r. [.[;tao5 ~hU aF•EGIFIC nELP~F~~P.LES_ -~----- - <br />txarn dcs: Fet:~ delivered in ~_ tiir~~y ~iiarn:a~U;, aa~a:.il:u:c prcdl.c°ra..) ~ ----~ -- •__^. <br />5. The G~unt~s'5 ~Jr`E6 IIRi : __-_-• .__ .._._.... <br />5. 'Primary Caunnl of Fcrtnrrnrmcc. Crusty tJa-ne: _ _ <br />(COIN6RB$SIOhtAL I.l[STRICT ij TatJST Bc IDETdTIFIE[]y C.~n;J~s51i~i1~l District ~. -_ <br />7. "Courtly Cf [iunrfit: i:5in_y c County: [-] Yes ^ V9 Cc;~nty hlarnc: - --••_ _-- <br />S:atu:~firt~~ l Ycs n Pla <br />hte~tiorak ^ Yes C: r.., <br />S. If the ans~rer tr.~ gaertinn nwn~,.:r ? i~'Rc;~ anal".list the c~~unlivs recwi~ing h[:~rfit <br />'?rirnary County of F'erformar,re: Cr:~,nTy in ~vhr~Fi grantee is 1ocalnd and t:vunfy in wjliCfl fire rrlaf4rrty Of tJ't2 <br />wart[ fakes place. <br />"'County of8encfif: ldentificdlocati0n('S) i1+Jdt' derive some beneiitfrom work orlvb fakes F,erlurrr,edrn another <br />~pullt~f Orin flee same county <br />