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i <br />Certification <br />North Carolina ARTS Grants Online (AGO) - Grassroots Arts <br />Program — Designated County Partners — Update Application/ <br />Report 2011 -12 <br />Orange County Arts Commission <br />Final Report #DCP0019 <br />Primary Contact: Ms. Martha Shannon <br />Phone: (919) 968 -2011 <br />Email: mshannon @co.orange.nc.us <br />Document Generated: Tuesday, July 3rd 2012, 12:13 pm <br />We certify that the accompanying Report represents all financial activity related to the receipt, <br />use and expenditure of funds granted by the State of North Carolina for this particular grant <br />during the fiscal year 2011 -12 and that the expenditures reported were for the purposes <br />appropriated by the General Assembly and in compliance with the applicable laws, <br />regulations, and terms and conditions of the grant documents. <br />This report is presented on the cash basis of accounting and is supported by our financial <br />records. Should a year -end audit of our agency show discrepancies with this report, we will <br />file an amended report. <br />By receiving funds from the State of North Carolina, including state or federal funds from any <br />source including those received from the North Carolina Arts Council, we will also submit for <br />the fiscal year shown above any reports required by the Local Government Commission under <br />General Statute 159 -33 or the Office of State Budget and Management under General Statute <br />143C -6 and the North Carolina Administrative Code, Section 9, subchapter 03M, as well as <br />Form 990 or 990 -N required by the Internal Revenue Service depending on our annual <br />organizational income and tax exempt status. <br />Treasurer /Financial Officer /Fiscal <br />Z <br />Agent �v """".. /✓ , ! `f�� <br />Authorizing Official /Fiscal <br />7/1' <br />— 7/ <br />#DCP0019 Pagel 1 <br />