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26 <br /> Such written acceptance may be upon or at the end of a copy of this Franchise Ordinance <br /> and it shall state and express the acceptance of said Franchise and its terms, conditions <br /> and provisions; and Grantee shall agree in said written acceptance to abide by, to observe <br /> and to perform the same according to all of its terms and provisions, subject to applicable <br /> state and federal law and shall declare that statements and recitals contained on said <br /> Franchise are correct and that it has made and does make the agreements and statements <br /> set forth in this Franchise. Acceptance herein referred to shall be in the following form: <br /> The undersigned, , in his/her capacity as <br /> of the Johnston Ambulance Service, Inc. and on behalf of that <br /> agency, does hereby accept and approve the foregoing and attached Franchise and all of <br /> its terms and conditions; and in consideration of the benefits and privileges granted to it <br /> does hereby agree to abide by, carry out, observe and perform all of the obligations and <br /> things provided to be carried out and performed by it in said Franchise approved by the <br /> Grantor Commissioners, subject to applicable state and federal law. <br /> This the day of , 2010 ' <br /> FOR GRANTEE: <br /> Printed Name and Title <br /> STATE OF NORTH CAROLINA ) <br /> ) <br /> COUNTY OF ORANGE ) <br /> On the day of , 2010 before me a Notary Public for the County and <br /> State aforesaid, personally appeared before me on <br /> behalf of said agency, acknowledges the signing and execution of the foregoing <br /> instrument. <br /> IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed by <br /> notarial seal on the day and year above written. <br /> Notary Public <br /> My Commission Expires: <br /> Page 19 of 23 <br />