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Please sign this agreement and return to NCHC at your earliest convenience. A signed <br /> agreement must be on file in our office for compliance with HUD HIV IS requirements. <br /> North Carolina Housing Coalition I Carolina Homeless Information Network <br /> 118 St. Mary's Street I Raleigh, NC 27605 <br /> Or FAX Signature Page to: (919)881-0350 <br /> BY SIGNING BELOW, THESE PARTIES HAVE ENTERED INTO A 2013-2014 CONTINUUM OF CARE <br /> PARTICIPATION AGREEMENT: <br /> HMIS LEAD AGENCY <br /> NORTH CAROLINA HOUSING COALITION, a North Carolina non-profit corporation <br /> Name: Satana Deberry <br /> Title: EXECUTIVE DIRECTOR <br /> PARTICIPATING CONTINUUM OF CARE LEAD AGENCY <br /> Date: {{ ''yy <br /> d'U n,� Npgjfj l nom- (Agency Name), <br /> A � G (Program Type). <br /> By. 11 rr —T— 1 t (Signature) <br /> Name: �(IGiZ�,r� 1�tP�XC <br /> Title: <br /> Address: I <br /> Address: WL�rnbDYZ>f?� , I L aQ <br /> E-mail: \v-&re_ P orl_r% 1 e Goo r-1, <br /> 6A7 �j <br /> Vic, q 04 <br /> Phone C1 3-�k at�- <br /> FAX: �CllCk l (64 " 305r;� <br />