Laserfiche WebLink
¶O '..Maili.ngAddr~.,~,. o " Nam~olA~pllcantOrganizatlon Cabarrus Co, Park~' &,ReCreation Dept. <br /> Contact Person's Name Joe Rosemond <br /> · :~-,~ Contact Person'a Title Special Proqrams Supervisor ' <br /> MallingAddress P.O. Box 707 <br /> <br /> : City Concord County ~abarrus <br /> State ~or'th Carolina Zip Code 28026-0707' <br /> AreaCode. Telephone(_Z.0_4___) 788 -- 6].50 Day <br /> ( 704. ) 786 -- 5883 Home <br /> Name end Position of AuthOrizing Official <br /> - - This-is aha person'who is legally ebl~ to obligate the applicant <br /> dames Lentz, Chairman, Board Of County Commissioners <br /> IRS tax delermination lette~X on file__ e~lached <br /> <br />¶ 1 Applicant RscalAgent This is the non-profit Payee to who~n checks should be issued if 1he Applicant <br /> Organization is not tax-exempt· <br /> Name of Organization <br /> Contact Person's Name <br /> Contact Person's Title <br /> Mailing Address <br /> <br /> City County <br /> State Zip Code <br /> Area Code, Telephone (.__}_ -- Day <br /> <br /> ( 1. -- Home <br /> Name end Position of Authorizing Official <br /> This is the person rate is legally able to obligate the fiscal agent <br /> <br /> IRS lax determination letter__ on file __ atlached <br /> <br />12 Cert~cafion We understand that failure to respond to any of the above items <br /> may seriously hinder the consideration of this application. We <br /> c~rtifythat w~ ere committed to the completion of Ihe proposed <br /> project in compliance w~th legal requirements and granting <br /> procedures. We certify that the information contained in this <br /> application, including ell atlachments end supporting materiels, <br /> is true end correct to the best of our knowledge. <br /> <br /> Signature oiAuthorizing Official Date <br /> <br /> t <br /> Signature of Piojoct Director Date <br /> <br /> Signature el Iqacal Agent Authorizing Official Date <br /> <br /> The applicant ahould retain · copy o! the application for its files <br /> and provide a copy to its local errs council Submit applications <br /> end supporting material in duplicate to: <br /> <br /> CABARRUS ARTS COUNCIL <br /> PO BOX 809 <br /> CONCORD, HC 28026-0809 <br /> <br /> II <br /> <br /> <br />