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DocuSign Envelope ID:2A6C2779-DD90-42AA-8E9F-5C9900BBFA38 <br /> COVER PAGE <br /> Applicant Contact Information <br /> Applicant Organization's Legal Name: Habitat for Humanity of Orange County <br /> Applicant Organization's Physical Address: 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 <br /> Applicant Organization's Mailing Address: 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 <br /> Applicant Organization's Web Address: www.orangehabitat.org <br /> Executive Director:Jennifer Player <br /> Telephone Number: (919) 932-7077 ext. 215 E-Mail: jplayer@orangehabitat.org <br /> Tax ID Number: 58-1603427 <br /> Funding Request <br /> Please list all Fiscal Year 2021 Human Services(HS)funding requested for all programs and the proposed <br /> use of funds(please list program name only) <br /> Program Carrboro-HS Chapel Hill-HS Orange County-HS Total <br /> Home Preservation $0 $21,312 Personnel $76,133 Personnel $97,445 Personnel <br /> $7,110 Operations $7,110 Operations <br /> Totals $0 $28,422 $76,133 $104,555 <br /> Briefly explain your proposed use of funds: <br /> Habitat proposes to use a total of$104,555 in Human Services funding to complete at least 25 repair <br /> projects for low-to moderate-income homeowners in Chapel Hill and Orange County during FY2021 <br /> as part of Habitat's Home Preservation program. <br /> To the best of my knowledge and belief all information and data in this application is true and <br /> current. The document has been duly authorized by the governing board of the applicant. <br /> Signature:.SMXV41) f6frL-) 2020 1 11 <br /> g / / <br /> (JExecutivu Director Date <br /> Signature:./(� `� 1/11/2020 <br /> Board Chairperson Date <br /> Cover Page P a g e 6 of 19 <br />