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CIPA COMPLIANCE CERTIFICATION FORM <br />for Public Libraries <br />As the authorized library representative, I hereby certify that the library is <br />(check only one of the following boxes) <br />A. ❑ CIPA Compliant <br />The applicant library has complied with the requirements of Section 9134(f)(1) of the Library <br />Services and Technology Act. <br />OR <br />B. ❑ The CIPA requirements do not apply because no funds made available under the LSTA program <br />will be used to purchase electronic equipment capable of accessing the Internet or to pay for direct <br />costs associated with accessing the Internet. <br />Emery Ortiz <br />Printed name of library director <br />Signature of library dimctm <br />CIPA Compliance Certification Form <br />State Library of North Carolina <br />Attachment number 3 \n <br />G-7 Page 454 <br />