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DocuSa.Envelope ID: 8F46C2BA-AC7A-464D-B01A-1 E2581 855465 <br /> Page 2 of 2 <br /> 49 iredell 01 0 0 <br /> 50 Jackson 0 0 0 <br /> 51 Johnston 0 0 0 <br /> 52 Jones 0 0 0 <br /> 53Lee 0 0 0 <br /> 54 Lenoir 0 0 0 <br /> 55 Lincoln 0 0 0 <br /> 56 Macon 0 0 0 <br /> 57 Madison 0 0 0 <br /> D4MTW 0 0 0 <br /> 60 Mecklenburg 0 0 0 <br /> 62 Montgomery 0 0 0 <br /> 63 Moore 0 0 0 <br /> 64 Nash 0 0 0 <br /> 65 New Hanover 0 0 0 <br /> 66 Northampton 0 0 0 <br /> 67 Onslow 0 0 0 <br /> 68 Orange * 0 15,000 15,000 15,000 <br /> 69 Pamlico 0 0 0 <br /> 71 Pander 0 0 0 <br /> 73 Person 0 0 0 <br /> 74 Pitt 0 0 0 <br /> 76 Randolph 0 0 0 <br /> 77 Richmond 0 0 0 <br /> 78 Robeson 0 0 0 <br /> 79 Rockingham 0 0 0 <br /> 80 Rowan 0 0 0 <br /> D5 R-P-M 0 0 0 <br /> 82 Sampson 0 0 0 <br /> 83 Scotland 0 0 0 <br /> 84 Stanly 0 0 0 <br /> 85 Stokes 0 0 0 <br /> 86 Surry 0 0 0 <br /> 87 Swain 0 0 0 <br /> D6 Toe River 0 0 0 <br /> 88 Transylvania 0 0 0 <br /> 90 Union 0 0 0 <br /> 92 Wake 0 0 0 <br /> 93 Warren 0 0 0 <br /> 96 Wayne 0 0 0 <br /> 97 Wilkes 0 0 0 <br /> 98 Wilson 0 0 0 <br /> 99 Yadkin 0 0 0 <br /> Totals 0 0155,194 <br /> . ,or Sign - "Pi- =-DPH Section Chief <br /> Sign d Date.-DPH Program Administr to <br /> i ,' , / „a,„44_,,, of -2 ,,,VV7 le, / -*it% ......._ 2 '9" I/ '-,2 <br /> sign : d !ate DPF�. ra ce��u � � � .w � �� � ". .. / <br /> i d Si.n an at DP Bud et cer il <br /> . ,, <br /> http://atc.dhhs.state.nc.us/WICGridPrintas x 22/20 <br /> P 22/2017 <br />