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North Carolina Martin Luther King, Jr. Commission <br />1318 Mail Service Center, Raleigh, North Carolina 27699-13) 18 <br />Telephone: (919) 733-7996 <br />Fax: (919) 733-7940 <br />Grantee's Acceptance and Understanding <br />The North Carolina Martin Luther King, Jr. Commission is providing a grant in the amount of $1500 to Orange <br />County Human Rights and Relations Department for the 2002-2003 grant cycle. <br />This form assures the North Carolina Martin Luther King, Jr. Commission (Commission) that the Grantee will meet <br />all requirements listed below: <br />I . The grant will be used for the purpose specifically set forth in the submitted application. <br />2. The written final report will be completed and submitted to the Commission no later than September 15, <br />2003. <br />3. The grantee agrees to acknowledge on program literature and publicity information that partial funding was <br />received from the North Carolina Martin Luther King, Jr. Commission. <br />4. Records of receipts and disbursements will be maintained by Grantee and such books and records will be <br />made available to the Commission, or its representative, upon request. <br />5. This grant is not earmarked for transmittal to any other entity or person, whether or not mentioned in <br />Grantee's proposal or in any other communications with the Commission. Rather, Grantee accepts and will <br />retain full control of the grant's disposition and full responsibility for compliance with its terms and <br />conditions. <br />6. The Grantee acknowledges that there is no conflict of interest or appearance of conflict of interest between <br />the North Carolina Martin Luther King, Jr. Commission and the Grantee. <br />7. The person signing below certifies his or her authority to execute this agreement on behalf of Grantee. <br />IN WITNESS WHEREOF, this Grantee Acceptance and Understanding is duly executed this day of <br />, 2003. <br />Organization Name <br />Mailing Address <br />Tax Identification Number <br />Authorized Representative Signature <br />Notary Public (official seal) <br />Area Code/Telephone Number <br />Title of Representative <br />Date Notarized <br />