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Memorandum of Disposition

  1. Craven County North Carolina Health Preservation Innovation
  2. Provide Street address of where item currently is located.
  3. *Digital Photo must be attached with electronic submission of this MOD form*
  4. If disposition is approved, will relocation of the asset be necessary?
  5. Choose One
  6. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  8. This field is not part of the form submission.