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State of North Carolina, County, of <br /> <br /> Appendix. B <br />Certified Statement <br /> <br />Pursuant to G.S. 136-44.27, the North Carolina Elderly and Disabled Transportation <br />Assistance Prograph, this is to certify that the undersigned is the duly elected, qualified and <br />acting chairperson of the Board of County Commissioners of the County of <br /> , North Carolina, <br />and that the following statements are true and correct: <br /> <br /> 1. That the funds received pursuant to G.S. 136-44.27 will be used to provide additional transportation <br /> services for the elderly and disabled, exceeding the quantity of trips provided prior to the receipt of <br /> these funds. <br /> <br />That the funds received pursuant to G.S. 136-44.27 will not be used to supplant e:dsting Federal, <br />State or local funds designated to provide elderly and disabled transportation services in the county. <br /> <br />That the funds received pursuant to G.5. 136-44.27 will be used in a manner consistent with the <br />local Transportation Development Plan and application approved by the NC Depa,hnent of <br />Transportation and the Board of Commissioners. <br /> <br />4. That any interest earned on these funds will be expended in accordance with G.S. 136-44.27. <br /> <br />5. That the funds received pursuant to G.S. 136-44.27 will not be used toward the purchase of capital <br /> equipment. <br /> <br />WITNESS my hand and official seal, this <br />Attest: <br /> <br />day of ,19 . <br /> <br />Cerrif3dng Official <br /> <br />Board of County Commissioner~ <br />Chabpemon · <br /> <br />State of North Carolina <br />County <br /> <br />Subscribed and sworn to me this <br /> <br />County Manager/Administrator <br /> <br />day of ,19 <br /> <br />(SEAL) <br /> <br />Notary, Public ' <br /> <br />My commission expires <br /> <br />Address <br /> <br />*Note that the signatures on thin statement should be those of four (4) separate individuals. <br /> <br /> <br />