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I1. HAILING ADDRESS game 9f Appllcant Organization ~abarrus Co. Pa~k[ g Rec~eattnn nept, Contact Personts Name Joe Rosemond Contact Person~s Title Spec~a! Pr0Qrams Supervisor Haillng Address PO Box 707 City £nnrnrd County_Caharru~ State North Car01ina Zip Code 28026-0207 Area Code, Telephone(704 ) 785-74]] Day (ZO'~'~-)' 938-5246 Night Name and Position of Authorizing Official This ~s the person who is legally able to obligate the applicant James Lentz~ Chairman-Board of County C0mmiss~oner~ IRS tax determination letter X on file attached 12. APPLICANT This is the non-profit Payee to whom checks should be issued if FISCAL AGENT the Applicant Organization is not tax-exempt. Name of Organization Contact Person's Name Contact Person~s Title Mailing Address CITY County State Zip Code Area Code, Telephone { ) Day ( )' Night Name and Position of Authorizing Official This is the person ~ho is legally able to obligate the fiscal agent. IRS tax determination letter on file attached 13 CERTIFICATION ~e understand that failure to respond to any of the above items may seriously hinder the consideration of this application. ~e certify that ~e are corr~itted to the completion of the proposed project in compliance with legal requirements and granting procedures. ~e certify that the information contained in this application, including all attachments and supporting materials~ is true and correct to the best of our knowledge. Signature of Authorizing Official Date Signature of Project Director Date Signature of Fiscal Agent Authorizing Officlal Date Hail application to: Cabarrus Arts Council, Inc. 23 Union Street, North Concord, NC 28025 Telephone: 782-6610