Orange County NC Website
<br /> <br />Date <br />Applicant's Federal Tax I.D. <br />Number (required) <br />FOR THE APPLICANT: <br />BY: <br />Signature <br />Kenneth T. Chavious <br />Typed Name <br />Finance Director <br />Date <br />Title <br />FOR THE STATE: <br />BY: <br />Signature <br />Typed Name <br />Title <br />a~v;rwed 218/02 Page 4 of 7 Rev. 06/01 <br />