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County of <br /> <br /> Appendix B <br /> <br /> · ~ Ceded <br /> <br />P~su~ to G.S. 136~.27, ~e No~ C~a Elderly ~d H~pped ~nn~po~fion <br />~slst~ee ~o~m, ~is is to ce~y ~at ~e ~de~igned is ~e d~y elect, qu~md ~d <br />act~ff cha~a~on of ~e Bo~d of C0~t~ Co~ssione~ of ~e Co~ of , <br />Nor~ Carol~a, ~d that ~e fo~ox~g s~men~ ~e ~e ~d co~t: <br /> <br /> 1. That ~e f~ re~ived p~nt ~ G.S. 136~.27 ~11 ~ ~d ~ pm~de ad~on~ ffaas~a~on se~s <br /> for the elderly and handicap~d, ex~edinff ~e q~nfi~ or,ps pm~d~ phor ~ ~e ~ipt of these f~. <br /> <br /> 2. That ~e f~ds re~ived p~nt ~ O.S. 136~.27 ~11 not ~ ~ed ~ suppler efisfing Federal, Sta~ ar Io~l <br /> funds desi~ated ~ p~de elderly and han~p~d ~ans~afion se~s in ~e ~unty. <br /> <br /> 3. That [he f~ re~ived p~t ~ G.S. 136~.27 ~11 ~ ~d in a m~nner ~nsis~t ~ ~e l~al <br /> ~aasportaficn Developmeat PI~ approved by [he NC Dep~ent of~s~foa and ~he Bo~ ~f <br /> Co~ssione~. <br /> <br /> 4. It is under,od that all qu~rly ~l~a~ons ~ [he Co~W p~nt ~ G.S. 136~.27 subs~uent <br /> ~ ~he fi~t al]o~fioa ~11 ~ made foHo~g the r~ipt of~e p~ess re~ for ~e pm~ding qu~r by the <br /> No~h Carolina Dep~ent of~anspo~fion, P~l~c ~s~fion Di~sion. <br /> <br /> 5. That any in,rest ea~ed on these f~ ~11 ~ e~nded in a~an~ ~ G.S. 136~4.27. <br /> <br />WIT~SS my h~d and o~cial seal, ~is. day oF ,19 <br />Attest: <br /> <br />Cer6 £ying Ollldn| Boar~ ofCounty Commls~ionem <br /> Chairperson <br /> <br /> County/Vlanager/Administ rator <br /> <br />State of North Carolina <br />County <br /> <br />Subscribed and sworn to me this day of ,19 . <br /> <br />(SEAL) <br /> Notary Public <br /> <br />My commission expires, <br /> Addres~ <br /> <br /> <br />