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_. <br />___ ____ <br />FY2004-2005 CT Application <br />FederaUState Certifications <br />USE LOCAL LETTERHEAD STATIONARY <br />SAMPLE LOCAL SHARE CERTIFICATION FOR FUNDING <br />(.4LL APPLICANTS MUST PRESENT AND RETURN THIS SIGNED FORM FVITH.APPLICATIOIV) 5 <br />I, the undersigned representing The County of Orange , do hereby <br />(Authorized Applicant/Subrecipient) <br />certify to the North Carolina Department of Transportation that the required local funds for the FY2005 <br />Community Transportation Program are available. <br />__ _. <br />We are applying for the~following amounts: <br />Project Total Amount Local Share <br />Administrative /Emp Dev. $ 191.221 $ 28.638 (15%) <br />Capital (Vehicles & Other) $ 0 $ (10%) <br />Facility $ 0 $ (10%) <br />Technology $ 5200 $ 520 (10%) <br />TOTAL $ 196.421 $ 29,158 <br />(Total of Projects) (Total Local Share) <br />The Local Share is available from the following sources: <br />Source of Funds Amount <br />Orange County General Funds $ 29,158 <br />TOTAL <br /> <br /> <br />These funds will be available as of July 1, 2004 for the FY2005, which has a period of performance of July 1, 2004 - <br />June 30, 200. rA f <br />rV I <br />Signature of Applicant u orized Official <br />Title <br />dit ~ a re r' ~ ~ (~ (Lsa ~ nl <br />Printed NaYne <br />. ir1-~~63 <br />Date <br />W <br />Section II <br />Page 13 of 19 <br />