Laserfiche WebLink
I1, HAILING A00RESS Name of Applicant 0rganlzatlon CabarrusCo. Perks&Rear, DeFt, <br /> Contact Person's Name Joe Rosamond <br /> Contact Personfs Title ~peeia] ~rograms Superwsor <br /> Nailing Address ~u Uox 7U? <br /> <br /> City ConCord __County Cebarrus . <br />_ State NC ZIp Code 28026-0?0? ' ' __ <br /> Area ~ode, Teiephone[?O4 ) 788-6150 Day <br /> (?0'~ ?86-5883 Night <br /> Name and Position of Authorizing Official <br /> This ts the person who Is legalty able to obligate the applicant <br /> James Lentz~ Chairman~ Board of County CommiR~oners' <br /> I~S tax determination let'ter X on fha attached <br /> <br /> 12. APPLICANT Thls Is the non-profit Payee to whom checks should be issued if <br /> FISCAL AGENT the Applicant Organization is not tax-exempt. <br /> Name of Organizatlon <br /> Contact Person~s Name <br /> Contact Person~s Title <br /> Hailing Address <br /> <br /> CITY County <br /> State Zip Code <br /> Area Code, Telephone ( ) Day <br /> (' I Night <br /> Name and Position of Authorizing Official <br /> This is the person who Is legally able to obligate the fiscal <br /> agent. <br /> <br /> IRS tax determination letter on File attached <br /> <br /> CERTIFICATION ~e understand that failure to respond to any of the above items <br /> may seriously hinder the conslderation of this application. ~e <br /> certify that ~e are con~nitted to the completion of the proposed <br /> pro~ect in compliance ~Ith lega! requirements and granting <br /> procedures. ~e certify that the information contained in this <br /> application, including all attachments and supporting materials, <br /> is true and correct to the best of our knowledge. <br /> <br /> Signature of Authorizing Official Oate <br /> <br /> Signature of Project Oirector Date <br /> <br /> Signature of Fiscal Agent Authorizing Official Date <br /> ~ail application to: <br /> Cabarrus Arts Council, Inc. <br /> 2~ Union Street, North <br /> Concord, NC 28025 <br /> Telephone: 782-6610 <br /> <br /> <br />