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GJ <br /> RESOLUTION <br /> DESIGNATION OF APPLICANT'S AGENT <br /> North Carolina Division of Emer enc Mans ement <br /> Organization Name(hereafter named Organization) Disaster Number: <br /> Qrap FE -Ll 1l(-p- -M <br /> Applicant's SAte Cognizant Age cy for Single Audit purposes(If Cognizant Agency is not assigned,please indicate): <br /> Applicant's Fiscal Year(FY)Start <br /> Month: Da <br /> Applicant's Federal Employer's Identification Number <br /> <br /> Applicant's Federal Information Processing Standards(FIPS)Number <br /> 0Y7 - 155 - <br /> PRIMARY AGENT SECONDARY AGENT <br /> Agent's Name Agent's Name <br /> Organization 0r Organization <br /> Qv� � Courr <br /> Official Position Official Position <br /> ' f-inov�c.�al rv�CeS Man r ti ah <br /> Mailing Address Mailing Address <br /> �•�• I "�l•O• u t I <br /> City,State,Zip City,State,Zip <br /> i11sb ro i 11 v h C <br /> Daytime Telephone Daytime Telephone • <br /> -Ll 15 - Z4 152) <br /> Facsimile Number .Facsimile Number <br /> "I l mot-(oy .. 3Z �I�- L �{-• � 2 <br /> Pager or Cellular Number Pager or Cellular Number <br /> y2.8- obq(p <br /> BE 1T RESOLVED BY the governing body of the Organization(a public entity duly organized under the-laws of-the State of North Carolina) <br /> that the abovb-named Primary and Secondary Agents are hereby authorized to execute and file applications for federal and/or state assistance on <br /> behalf of the Organization for the purpose of obtaining certain state and federal financial assistance under the Robert T.Stafford Disaster Relief <br /> &Emergency Assistance Act,(Public Law 93-288 as amended)or as otherwise available.BE IT FURTHER RESOLVED that the above-named <br /> agents are authorized to represent and act for the Organization in all dealings with the State of North Carolina and the Federal Emergency <br /> Management Agency for all matters pertaining to such disaster assistance required by the grant agreements and the assurances printed on the <br /> reverse side hereof. BE IT FINALLY RESOLVED THAT the above-named agents are authorized to act severally. PASSED AND <br /> APPROVED this dg of 20 <br /> GOVERNING BODY CERTIFYING OFFICIAL <br /> Name and Title Name 4 w <br /> Name and Title Offic' ositi �.-�•e�.'ek=L <br /> Name and Title Daytime Ulephone <br /> Zw <br /> CERTIFICATION <br /> I, Dpy�,,t... (Name)duly appointed and (fJ02&j(_6 ��itle) <br /> of the Governing Body,.do hereby cert' that a above is a true and correct copy of a resolution passe and <br /> approved by the verning Body of (Organization)on the day of <br /> At 20! <br /> Date: Signature: <br /> Lj Rev.06/02 <br /> z ' <br /> 17 <br /> >be <br />