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Salisbury-Rowan Community Service Council, Inc. ~ <br /> <br /> I~a~-~ ~;~airpers~:)n ' Title <br /> <br />Date: <br /> <br />Offices of EconomiC OPportunity, North Carolina Department of Health & <br />Human Services <br /> <br />By: <br /> <br />Director Title <br /> <br />Date: <br /> <br />Cabarrus County Department of Aging <br /> <br />Applicant's Name <br /> <br />331 Corban Avenue <br />Post Office Box 707 <br />Concord, NC 28025 <br /> <br />Address <br /> <br />By: <br /> <br />Authorized Official: <br />President, Chief Executive Officer or <br />Authorized Designee <br /> <br />Executive Director <br /> <br />Signature- <br /> <br /> <br />