Orange County NC Website
DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued <br /> Provider's OktORAcinacy_AQpiication <br /> UA I KIN <br /> d) To the best of my knowledge and belief all information and data in this application is <br /> true and current. The document has been duly authorized by the governing board of the <br /> applicant. <br /> zy <br /> -7-7/4"W <br /> Signature: 6 / <br /> / Executive Director <br /> Signature: <br /> :oard Chairperson Date <br /> Main Application 1/21/2016 3:50:16 PM Page 4 of 24 <br />