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10 MailingAddress Name of Applicant Organizal~on, Cabarrus Co, P_arks & Recreation Dept, <br /> Contact Person's Name ' Joan L, Swarinqe!~ <br /> Conlact Person's Tide Special Populations Sqpervisor <br /> Mailing Address ... Post Office Bo>( 707 <br /> <br /> city Concord County Cabarrus <br /> : ~ ,- State NC Zip Code 28__026-0707 <br /> ., AreaCode,.Telephone{ 70~ 788- 6150 Day <br /> (704_) 786- 0307 Home <br /> ·: Name and Position of Authorizing Olficial <br /> Th~s ~s tF~e parson who ~s legally able to obhgate the apphcant <br /> James ~ Chairman, B_oard <br /> IRS tax delermination lener~X on file__ atlached <br /> <br /> Applicant FiscalAgent This is the non-profit Payee Io who'm checks should be issued ii the Applicant <br /> Organization is not tax-exempt. <br /> Name of Organizallon <br /> Contact Person% Name <br /> Contact Person's <br /> Mailing Address __ <br /> <br /> City County <br /> State Zip Code. <br /> Area Code, Telephor~e ( _) -- Day <br /> ( ) -- Home <br /> Name end Position of Aulhodzing Official <br /> This is the person who is legally able to obi/gate the fiscal agent <br /> <br /> IRS tax delermination letler__ on file__ attached <br /> <br />12 Certification We understand Ihaf failure to respond to any of the above items <br /> may seriously hinder the consideration of this application. We <br /> certify that we ere committed fo the completion of the proposed <br /> project in compliance with legal requirements and granting <br /> procedures. We certify that the information contained in this <br /> application, including ell attachments and supporting materials. <br /> <br /> Signature of Authorizing Official Date <br /> Signature of P~oject Director Date <br /> <br /> Signature of Fiscal Agent Authorizing Offlclal Date <br /> <br /> The applicant should retain a copy of the application for its files <br /> end provide ~ ~:opy lo its local arts council. Submit applications <br /> and supporting material in duplicate <br /> <br /> C/~US ~TS CO~CIL <br /> PO BOX 809 <br /> ~NCO~, NC ~28026-0809 <br /> <br /> <br />