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Agency Name <br />OFFICE of <br />ECONOMIC OPPORTUNITY <br />Community Services Block Grant [CSBG] <br />Documentation of Submission to County Commissioners <br />Background The North Carolina Administrative Code [10A NCAC 97C.0111 (b)(1)(A)] requires that <br />each CSBG grant recipient submit its Community Anti - Poverty Plan [grant application] to each <br />County Commissioner Board that it serves. <br />Instructions This form is to be completed and notarized by the Clerk to the Board. <br />Agency Name: <br />County: <br />Date of Application Submission: <br />[Note: This application should be submitted to the County Commissioners at least thirty [30] days prior to <br />application submission to the Office of Economic Opportunity [OEO]. The grant application is due OEO <br />February 15, 2012.] <br />Clerk to the Board should initial all items below. <br />Clerk to the Board <br />Witness /Notary <br />The agency submitted a complete grant application for Commissioner review. <br />The Clerk to the Board will be responsible for assuring that the application is <br />distributed to the Commissioners. <br />Commissioners' comments provided those to the agency. (If applicable) <br />Date <br />Date <br />Fiscal Year 2012 -13 Community Services Block Grant Application <br />Page 24 of 24 <br />Attachment number 1 <br />F -7 Page 202 <br />