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Conflict of Interest Verification (Annual) <br />We, the undersigned entity, hereby testify that our Organization's Conflict of Interest <br />Acknowledgement and Policy adopted by the Board of Directors/Trustees or other <br />governing body, is on file with the North Carolina Department of Health and Human <br />Services (DHHS). If any changes are made to the Conflict of Interest Policy, we will <br />submit a new Conflict of Interest Acknowledgment and Policy to the Department <br />(DHHS). <br />Sal <br />Nai <br />I Rowan Community Action Agency, Inc. <br />Organization <br />ctor's AV4Forized Agent Date <br />Stanley Wilson 25�E� ZVR6 -67-0 _- <br />Printed Name of Contractor's Authorized Agent Title <br />Signature of Witness Date <br />�J:tMeAl, e,A-1 41'1— APm,,n/« `T4'A -7ye � «r <br />Printed Name of Witness Title <br />NCDHHS COM015 Conflict of Interest Verification (9.19.13) <br />F -13 <br />Attachment number 1 <br />Page 275 <br />