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3 <br /> If you are in agreement with the above terms, please sign in <br /> the space indicated below and provide us with your Social <br /> Security Account Number. <br /> Sincerely, <br /> Daniel B. Reimer <br /> Health Director <br /> I, 4GG�%L �%l(:�lA,� am in agreement with the above <br /> signature <br /> terms. My Social Security Account Number is - <br /> Date: <br /> This instrument has been pre-audited <br /> in the manner required by the Local <br /> Government Budget and Fiscal Control Act. <br /> Ken T. Chavious, Finance Director <br /> Moses Carey, Jr. , Chair <br /> Orange County Board of Commissioners <br /> LOCONT.DOC <br />