Notarized Conflict Of Interest Policy Form printable pdf download

Notarized Conflict Of Interest Policy Form

ATTACHMENT E

NOTARIZED CONFLICT OF INTEREST POLICY

State of North Carolina

County of __________________________________

I, _________________________________________, Notary Public for said County and State,

certify that _________________________________________________ personally appeared

before me this day and acknowledged that he/she is _________________________________

of ______________________________________ and by that authority duly given and as the

act of the organization, affirmed that the foregoing Conflict of Interest Policy was adopted by

the Board of Directors in a meeting held on the _________ day of __________, ___________.

Sworn to and subscribed before me this _________ day of ______________________, ____.

___________________________________

(Official Seal)

Notary Public

My Commission expires ______________________________, 20 ___

Instruction for Organization:

Sign below. Also, attach page two after it is adopted by the Board OR replace page two with

the current adopted conflict of interest policy.

___________________________________________

Name of Organization

___________________________________________

Signature of Organization Official

DHHS Conflict of Interest

(05/09)

Notarized Conflict Of Interest Policy Form