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I <br />APPLICATION <br />PUBLIC SCHOOL BUILDING CAPITAL FUND <br />NORTH CAROLINA EDUCATION LOTTERY <br />County: Orange County <br />LEA: Chapel Hill - Carrboro City Schools <br />Address: P.O. Box 8181, Hillsborough, NC <br />Approved: <br />Date: <br />Contact Person: Clarence Grier <br />Title: Financial Services Director <br />Phone: (919) 245 -2453 <br />Project Title: FY 2011 -12 Debt Service (Spring 2006 Private Placement) <br />Location: <br />Type of Facility: <br />Short description of Construction Project Debt Service associated with Spring 2006 Private Placement <br />issued June 2007 for Chapel Hill - Carrboro City Schools Elementary #10 <br />Estimated Costs: <br />Purchase of Land $ <br />Planning and Design Services <br />New Construction <br />Additions / Renovations <br />Repair <br />Debt Payment/ Bond Payment <br />TOTAL <br />Estimated Project Beginning Date: July 2011 <br />492,654.00 <br />$ 492,654.00 <br />Est. Project Completion Date: June 2012 <br />We, the undersigned, agree to submit a statement of state monies expended for this project within 60 <br />days following completion of the project. <br />The County Commissioners and the Board of Education do hereby jointly request approval of the above <br />project, and request release of $ 492,654.00 from the Public School <br />Building Capital Fund (Lottery Distribution). We certify that the project herein described is within the <br />parameters of G.S. 115C -546. <br />(Signature — Chair, County Commissioners) <br />(Signature —Chair, Board of Education) <br />Form Date: July 01, 2011 <br />(Date) <br />(Date) <br />