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001: 2, <br /> REHABILITATION CONTRACTOR REGISTRATION APPLICATION . <br /> Page 3 <br /> 17. DOES YOUR FIRM HAVE A RECENT FINANCIAL STATEMENT? YES NO X <br /> IF YES, PLEASE ATTACH WITH IRIS APPLICATION. _ <br /> 15. HAS THE COMPANY EVER BEEN PARTY TO OR INVOLVED IN ANY ACTION RELATED TO <br /> X <br /> DISCRIMINATION BASED UPON RACE, NATIONALITY, SEX, OR RELIGION? YES NO <br /> IF YES, PLEASE EXPLAIN: . <br /> ' . <br /> . <br /> - <br /> • . <br /> 19. HAS THE FIRM EVER CAUSED A LIEN FOR MATERIAL OR MECHANICAL WORK DEFAULT <br /> PAYMENT TO BE PLACED AGAINST A HOMEOWNER? YES 'NOX <br /> IF YES, PLEASE EXPLAIN: . <br /> • <br /> .., _ <br /> • ' <br /> 20. HOME ADDRESS OF OWNER: 223 Omega Road Durham, NC 27704 <br /> ... , <br /> THE UNDERSIGNED HEREBY AUTHORIZES AND REQUESTS ANY PERSON, FIRM OR, CORPORATION <br /> TO FURNISH ANY INFORMATION REQUESTED BY THE HOUSING REHABILITATION OFFICE OF <br /> ORANGE COUNTY, HILLSBOROUGH, NORTH CAROLINA IN VERIFICATION OF THE RECITALS <br /> COMPRISING THIS STATEMENT OF QUALIFICATIONS, DATED THIS 30 DAY OF December <br /> 1981 . <br /> Kid SmithNome Improvement Co. <br /> NAME OF FIRM <br /> BY: Kid Smith <br /> li-- <br /> TITLE: OWNER <br /> ----------7----77(;:----7 , <br /> ,. <br /> STATE OF .L.42:7 -1, i ) <br /> ) SS • , <br /> /COUNTY OF ' t-c4-. ca,•,,-;,4., ) <br /> --(^1 da <br /> iii: 'L-4 C • .,...7":- ---,-.e e..fl,1--, <br /> z2, e4. beg duly sworn/depostsapd says <br /> that keishe is" ,/&:777,-1 ,,,- - .:. . of <br /> Aitd that the answers to the foregoing questions and all statements therein contained <br /> are true and correct. ..-- <br /> . <br /> 5UB1RIBED AND SWORN tobefore me this 4-.6, day of <br /> 1 t> <br /> tiOTARY PUBLIC <br /> z.. <br /> • ,, ,, <br /> My Commission ExpireS:. a,""2 4- !:"6 '-'"‹.7 , 19 eek: <br />