Orange County NC Website
Browse       Search
Aug 18 2023 01 :15PM HP Fax page 3 <br />CONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY <br />State of N � <br />County A\a.roaoc.e, <br />I, -,--,-+-(.J ... 1 <br />..... 0 .... d ... a.�K�._S_11_1F-p-=-l--==>=-------· Notary Public for said County and State, certify that <br />_,A'---'-'-Jnu...O...,,.e;�t...,t"-"e.."--"'.H'--''-(!.--"l>o=--... ri------personally appeared before me this day andacknowledged <br />[name of Organization] <br />and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of <br />Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting helcl <br />on the l O 'th day of �Ujl-t; , 2423 . <br />Sworn to and subscribed before me this ID 'th day of Au.a.,u� t , ZOZ3 \,,,,ij..,,,,,, .. ' � .. ��� .. ��i\ . ..A... 11 � � .l � .. U' i\ LtUW-t CJ. � l �T�J.. \ : \ (Offlcl� : l! f · J i • Notary Public l�\ "°ve\.,v ii_l,· <br />My Commission expires Ja.ouarv 25 202 Y \��}0._2:3 .• h. ��/1· I �"CE' °\'" . --------------�iriiiih"1�------,- <br />Instruction for Organization: Sign and attach the following pages aller adopted by the Board of Directors/Trustees or other <br />governing body OR replace the following with the current adopted conflict of interest policy. NCDHHS COl1015 (Rev. 4/11) DocuSign Envelope ID: 74375224-B7BF-4B07-89E3-8426200297F5