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Card <br />CONTRACT & FINANCIAL DOCUMENTS <br />INSTRUCTIONS: Please read and fill in the required information to the right of each field where applicable. Signatures <br />must match the Contract signatures. In the event the affixed signature(s) are no longer valid, a revised form must <br />be submitted prior to processing any contractual documents or submitting 'Request for Payments" or any other <br />financial documents. If more than two people will sign far the organization, this form may be duplicated. <br />SECTION I. <br />Date: <br />8/2/18 a.ry 6 FTrea u.f r <br />Legal Applicant Organization/Agency Name: <br />Cabarrus Soil and Water Conservation District <br />Federal Tax Identification Number: <br />56-6000281 <br />SECTION It. <br />Certification: <br />By affixing my signature below. I certify that person(s) identified are designated having legal authorization to sign on <br />behalf of the organization named in Section t., above, for purposes of executing contractual documents and preparing, <br />approving and executing all financial documents; including "Requests for Payments." I understand the legal implications <br />of any and all misrepresentation, which include but are not limited to defrauding the State of North Carolina, and certify <br />that the person signing below has full authority to execute this Agreement on behalf of the named organization. <br />NON-GOVERNMENTAL ORGANIZATIONS ONLY Must match Contract signature) <br />Board Chair, Executive Director, etc. <br />Financial Representative, Treasurer, etc. <br />Print Name & Title: <br />Print Name & Title: <br />Signature: <br />Signature: <br />GOVERNMENTAL ENTITIES Must match Contract <br />signature) <br />Authorized Governmental Official <br />Chief Fiscal Officer <br />P Name & Title. <br />Print Name & Title: <br />Signature: <br />Signature: <br />u 8-6-,rr <br />NCDA&CS - Signature Card — NGO & GovernmenWl Page 1 of 1 <br />Rov 7114; 1/17;11117 F-7 Page 182 <br />