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Signature: <br /> The undersigned Energy Provider hereby agrees and warrants to the State of North Carolina and the <br /> County Department,that the undersigned will comply with the terms and conditions outlined in this <br /> Agreement to receive monies under the Low-Income Home Energy Assistance Program. <br /> I hereby declare that I have read and understand the above and agree to comply and abide with the <br /> terms and conditions specified while participating in the program. <br /> Duke Energy Progress Angelina Noel <br /> eywax!rintLornpan y Na ;;��J (Print County Director Name) <br /> (Si naturey Representative) (Signature of County Director) <br /> 1A\� 5/)-31Ooa0 <br /> (Date) (Date) <br /> •D •-Lbs- ill i PO BOX 1066 <br /> 'Qn � (Print Mailing Address) (Print Mailing Address) <br /> M CLF4.1. 1C n-1140 Da Sanford NC 27331 <br /> CI <br /> Mint City,State,Zip Code) (Print City,State,Zip Code) <br /> vl 1 L 51'k'lo 1-Fia D (919)718-4690 <br /> nn(Telephone Number) (Telephone Number) <br /> 5t0- a 15 5 4-8 I anoel@leecountync.gov <br /> (Provider Federal ID Number(FEIN) SSN))or (Primary E-mail Address) <br /> 3P GoAsmnPAf L'&l(S cp Attu-?Y1Pr€ .con <br /> (Primary E-mail Address) V�l <br /> A✓V1,c1 114., 1 l <br /> Ch6tc, Lee.eounA‘611030 Oc borcea6sSore4 S <br /> 04/1 jfk D. a.,tvory.....L., <br /> DSS-8163(06/18) Page 3 of 3 <br /> Economic and Family Services <br />