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DocuSign Envelope ID: 167F763C-D16E-41 D3-B98F-F5E24EE9CC37 <br /> 1212/2016 WicGridFrint <br /> 51 Johnston 0 0 0 0' <br /> 52 Jones 0 0 0 0 <br /> 53 Lee 0 0 0 0 <br /> 54 Lenoir 0 0 0 0 <br /> 5s Lincoln 0 0 0 0 <br /> 56 Macon 0 0 0 0 <br /> 57 Madison 0 0 0 0 <br /> D4'M-T W 0 0 0 0 <br /> 60 Mecklenburg 0 0 0 0 <br /> 62 Montgomery 0 0 0 0 <br /> 63 Moore 0 0 0 0 <br /> 64 Nash 0 0 0 0 <br /> 65 New Hanover 0 0 0 0 <br /> 66 Northampton .0 0 0 0 <br /> .67 Onslow 0 0 0 0 <br /> 68:Orange 0 , 49,110 0 49,110 49,110 <br /> 69 Pamlico 0 0 0 0 <br /> 71 Pender 0 0 0 0 <br /> 73:Person 0 0 0 0 <br /> 74 Pitt 0 0 0 0 <br /> 76 Randolph . 0 0 0 0 <br /> 77 Richmond 0 0 0 0 <br /> 78 Robeson 0 0 0 0 <br /> 79 Rockingham . 0 0 0 TO <br /> 80 Rowan 0 0 0 0 <br /> D5 R-P-M 0 0 0 0 <br /> 82 Sampson 0 0 0 0 . <br /> 83 Scotland 0 0 0 0 <br /> 84 Stanly 0 0 0. 0 <br /> SS Stokes 0 0 0 0 <br /> 66 Surry 0 0 0 0 <br /> 87 Swain 0 0 0 0 <br /> D6 Toe River 0 0 0 0 <br /> 88 Transylvania 04 0 0 _ 0 <br /> _90 Union 0 0 0 0 . <br /> 92 Wake 0 0 0 0 <br /> 93 Warren 0 0 01 0 <br /> 96 Wayne 0 0 0 0 <br /> 97 Wilkes 0 0 0 0 <br /> 98 Wilson _ 0 0 0 0 <br /> 99 Yadkin 0 0 0 0 <br /> Totals 155;.194 0 155,194155,194 <br /> Sigt and_Date-OPH_P_ro ram Administrator Sign,_y. I-ta-DR.{ t c- :kite€ <br /> ( / iii" AA4 /).-72,.//‘ <br /> Sign id •:e-DPI-1 Co acts Office Ski nd Date-DPH Budge 2fficer'\,,afth,-. ,,,, ,_,,, ,,, dittii, 1.6 fah so 0 a- I )62 <br /> ala.,1 <br /> L.kti 0..71 /E// d .. <br /> http:C late,dhhs.stett&,nc.usalCGridPrint.aspx 2/2 <br />