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Rev. 11/22/02 <br /> 2003 Participation Form <br />NC Local Government Debt Setoff Clearinghouse Program <br /> <br />This certifies that the following local government entity intends to participate in the Local <br />Government Debt Setoff Collection Program for the 2003 calendar year: <br /> <br />Name of Local Government: <br /> <br />Local Debt Setoff Phone: Mailing Address: <br />Coordinator: <br /> <br />Date: <br /> <br /> Debbie Farmer (704)920- P.O. Box 707 <br /> <br />The local debt s.etoff coordinator will receive ail communications and is authorized to carry out the <br />requirements of the Debt Setoff Act and any agreem, ents entered herein to enable participation in debt <br />setoff. <br /> <br />Local Debt Setoff Contact: <br /> <br />IPhone: <br /> <br /> (704)920- <br /> 2122 <br /> <br />'l Mailing Address: <br /> P :O'.'Box .707- <br /> <br />Email: <br />dlfarmer@co.cabarrus.nc us <br /> <br />Debbie Fagmer <br /> <br />Email: <br /> dlfarraer@co, cabarrus. <br /> <br />The local debt setoff contact will be referred all calls from debtors via the automated voice response <br />system. <br /> <br />C.U,~ <br /> <br />,Local Debt Setoff Phone Number for Debtor Contact: (704) 920-2122 <br /> <br />This phone number will be provided to debtors via the automated voice response system <br /> <br />Please choose an option for data transmission <br /> <br />Customized Software: <br /> <br />2nd choiam <br /> <br />File Transfer ProtoCol: <br /> <br />1st cho~ae <br /> <br />by checking the appropriate box: <br /> I ' <br /> Hardcopy: <br /> <br /> (will require ,payment <br /> entry costs) <br /> <br />of data. <br /> <br />I, , (authorized official), attests that our loCal government will <br /> <br />follow the Written notice and he.ming requirements pursuant to GS 105A-5, prior to transmitting any <br />debts to the CLF, ARINGHOUSE for Submission for debt. setoff. <br /> <br /> <br />