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Attachrlrlent E , <br /> signature Card <br /> Division of Soil and Water Conservation <br /> CONTRACT & FINANCIAL DOCUMENTS <br /> INSTRUCTIONS: Please read and fill in the required information to the right of each field where applicable. <br /> Provide the requested printed and written signatures (in Blue Ink) of agency representatives in the designated <br /> areas. In the event the affixed signature(s) are no longer valid, a revised form must be submitted prior to <br /> processing any contractual documents or submitting "Request for Payments" or any other financial <br /> documents. <br /> SECTION I. <br /> Date: 12-4-12 <br /> Legal Applicant Organization/Agency Name: Orange Soil &Water Conservation District <br /> Federal Tax Identification Number: 56-6000327 <br /> SECTION ii'. <br /> Certification: <br /> By affixing my signature below, I certify that person(s) identified are designated having legal authorization to <br /> sign on behalf of the organization named in Section I., above, for purposes of executing contractual <br /> documents and preparing, approving and executing all financial documents; including "Requests for <br /> Payments". I understand the legal implications of any and all misrepresentation of a sole purpose of <br /> defrauding the State of North Carolina. <br /> NON-PROFIT ORGANIZATIONS ONLY <br /> Chairman of the Board of Directors(Contract Documents) Financial Representative Signature <br /> Print Name: Print Name&Title: <br /> S ignature: Signature: <br /> GOVERNMENTAL ENTITIES <br /> Appropriate Governmental Official(Secretary, Chief Fiscal Officer Signature <br /> Commi Toner,etc. 1 <br /> Pri - ame Title: Print Name&Title: <br /> ate, V 6-' Cy; V A-s k 6, <br /> Sign Signature: <br /> Signature Card—NPO&Governmental Page 10 of 11 <br /> NCDA&CS: Rev 7/11, 2/12, 5/12,7/12,8/12 <br />