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ATTACHMENT~E <br />NOTARIZED CONFLICT OF INTEREST POLICY <br />State of North Carolina <br />County of ~ (A r ~ ~ M <br />I, Q e.4o~A u $y k ,.1 ,Notary Public for said County and State, certify that <br />C (gar I e s ~• (~ ; ~ S o n ~ personally appeared before me this day and acknowledged <br />that helshe is t ~V1 A ~1 r fY~ Gi n of ~ 0 U S i n {~ P u~ {-~ ~ ~Q... <br />[enter name of entity] <br />and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy <br />was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the ~$+~` day of <br />march ~o . <br />Sworn to and subscribed before me this ~ d ~- .day of ~ ~ ~~ <br />,~~111111/~~ <br />`~~~~ .~BORq./}~~rri~ <br />~K1+li <br />(Official Seal) = ,'~ ' ~~ ~~ ~ O ~_ <br />~ ~ : x ` otary Public <br />~- ~ • ~ ~ O <br />- ~ ~ rc .~ <br />D~-a ~- ~v '• G . <br />My Commission expires f~i~ '•'•••••••'•; ~ ~` <br />~-- <br />Instruction for Organization: <br />Sign and attach"the following pages after adopted by the Board of Directors/Trustees or other governing body OR <br />replace the following with the current adopted conflict of interest policy. ' <br />OU S~ n ~ -4-o r (~~ P ~ 1 ~ ©P -~ <br />Name of Organiza 'on <br />Signature of Orga ization Official <br />NCDHHS COI1015 (Rev. 2/08) Page 12 <br />