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Docusign Envelope ID:OB18F280-87A5-4A76-8CD5-OD6337C1BB4C <br /> CONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY <br /> State of -5exA(r <br /> County _ R►\tt <br /> that , Notary Public for said County and State, certify <br /> \ <br /> `i?.^ ��t personally appeared before me this da and <br /> acknowledged Y <br /> that he/she is Prulai v of <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 held <br /> on the 18 jrV day of M <br /> Sworn to and subscribed before me this 2-$'�^ day of�_ t <br /> �pp,Y.Ave�j�� JONATHAN WILSON <br /> S Notary Public,State of Texas <br /> Comm.Expires 03-04 2028 <br /> (Official Seal) — Notary ID 128868910 <br /> Notary Public <br /> My Commission expires M ie-f L1 A <br /> rru rrrrrrrrrrrrrrrrrrrrrrrr�rrrrrrr a rrrrr�rrrrrrr urrrrrrrrrrrrrrrrrrrrrrrr u <br /> Instruction for Organization. <br /> Sign and attach the following pages after adopted by the Board of Directors/Trustees or other <br /> governing body OR replace the following with the current adopted conflict of interest policy. <br /> r <br /> Name of rg tion <br /> Sig f rganization Official <br /> NCDHHS C0I1015 (Rev.4/11) <br />