Orange County NC Website
FOR THE APPLICANT: <br />Date <br />BY: <br />Signature <br />Ke etla-T Chavintis <br />Typed Name <br />Finance Director <br />Title <br />FOR THE STATE: <br />BY: <br />Signature <br />Typed Name <br />Title <br />Applicant's Federal Tax I.D. Number (required) <br />Date