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l <br /> 45 <br /> Limited Waiver of Confidentiality EXHIBIT G <br /> Unemployment Tax and Wage Records <br /> BUILDING REUSE PROGRAM—Revision#3 2020-025-3201-2687 <br /> Name of Taxpayer �n _� 1���.�_ n _c - ,� �� }te iA,-, L—i-x,. <br /> Address; GXQ-c _rnit D(w Q — --- --___.---------- -_ __ . <br /> City: (v State: . -_ Zip: _- cJ� '�J Phone: <br /> NC Unemployment Insurance Acet Fed Tax 1D#: 09 <br /> Ic! <br /> I hereby waive any right to confidentiality,as found in N.C.G,S. 964 or otherwise, for <br /> the limited purpose of authorizing disclosure of certain information contained in the quarterly <br /> unemployment insurance tax records of the above-named taxpayer(hereinafter,"Company") <br /> Filed with the Division of Employment Security ("DES")of the North Carolina Department of <br /> Commerce to Orange County("Governmental Unit") and to the employees of the Rural <br /> Economic Division of the North Carolina Department of Commerce("Rural Division")and <br /> members of the North Carolina Rural Infrastructure Authority("Rural Authority") for the limited <br /> purpose of evaluating the issuance of and, in'the event of such issuance, administering and <br /> ensuring compliance with, a grant and loan pursuant to N.C.G.S. 143B-472.127 and .128. <br /> 1 recognize that DES is authorized to provide this information to the public officials of <br /> the Governmental Unit, the Rural Division and the Rural Authority in the performance of their <br /> public duties and that the verification of employment information for the purpose of <br /> administering the grant and loan at issue is within the scope of the public duties of the <br /> Governmental Unit,the Rural Division and the Rural Authority. I hereby authorize DES to <br /> disclose information contained in the Company's quarterly unemployment insurance tax records <br /> (the NCUI.101 or successor form)to the Governmental Unit, the Rural Division and/or the <br /> Authority for these purposes. <br /> I recognize that unemployment insurance tax information provided in the aggregate to <br /> DES and disclosed to the Governmental Unit, the Rural Division and/or the Authority,and the <br /> Company's aggregated tax and wage information provided to or otherwise in possession of the <br /> Governmental Unit,the Rural Division and/or the Authority,may be treated as public <br /> information. This waiver is not Intended to release the Governmental Unit,the Rural Division <br /> and/or the Authority from any obligation they may have under North Carolina law to maintain <br /> the confidentiality of any and all information which could reveal or permit someone to ascertain <br /> the identity of any Individual employee or that employee's line item unemployment insurance <br /> tax or other tax or wage information. <br /> Signature Chief Financial Officer or Other Authorized Company Official <br /> (� <br /> _ Printer.�lamcs- I:_ � Title <br /> Waiver ofConfdentiality- 1 <br /> i <br /> i <br /> i <br />