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NGRTM CAROLINA DEPARTMENT OF AGRICULTURE AND CC,7NSUMIER SERVICES
<br />SPECIALTY CROP BLGCK GRANT PROGRAM
<br />C~NTRACTk~AL & FINANCIAL D~GUMENTS
<br />SIIaNATURE CARD FURI~I
<br />INSTRUCrIOVS: P'.ease rear! ancf fill ill It,d :eyuired infcrmafion to the right nt porch field whore applicable, f'rovicJp the requested printed and Hri:tr:n =iyelatu'66 of agency
<br />repre~entaGvds In tie c+csignated ar~riall. In Ihrl etwnl Llb aiflxsd Slr~naiurP(s) Grp nor lorlyar valid, r IAvisecl ;'onn miLSt hp Sutlr•litied p~lar to processin:, any wniractual
<br />doramlerlla ul subma~Cp "RegveStfpr~~ymr,nir' ul anyothsrlEnancial dacumpnts
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<br />lx:gat napli;an• r7 • ani~alic,n + ~•uncyName:
<br />FExJolal Tax Edenti5cat+on Mumt:elr:
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<br />Cerlifirblion:
<br />ey aff,kirg my signature belo~.v, I car;iiy Inai ~ersonfs) identifies k~lo,n• sre dusay•iadod hhvlr.g legal anthnrizatian lu 3iyn on aehalf of :hP orgArlizatirin named in Secfian 1„
<br />a0uve. fur purposes e1 ey~!rutinr, c~lntr,ra~+l dccu.`nents and preparing, apprr.•vir•g anu awocutirrg all finanaal doouu,ranlb: including "Req~wsts for Pa~ar•enL*'". I understand
<br />;hP leyal impllptJOns of any and ell misreprestllsliuu of a1 uffical fryr rhp Snla parpara of dcira~.J ng the otate of NorCl L'~rvl6:a.
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<br />$ignature: Signaturta,
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<br />Slgnatu`c, 5igne:ure:
<br />Signa~ure Gard Form U8 - 44~
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