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IN WITNESS WHEREOF, the County and the Provider have executed and 7 <br />entered into this Agreement as of the day and year first above written. <br />ORANGE COUNTY, NORTH CAROLINA <br />By: <br />PRINTED NAME OF PROVIDER <br />Laura Blackmon, Manager <br />Date <br />This instrument has been pre- <br />audited in the manner required by <br />the Local Government Budget and <br />Fiscal Control Act. <br />By: <br />Date: <br />(Mailing Address) <br />(Provider Federal Tax ID#) <br />FINANCE OFFICER <br />NAME OF SUPERVISING DEPARTMENT <br />County Risk Manager <br />Signature of Department Director <br />