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USDA Forest Si�rvlc:e OMB 0596-0217 <br />FS --1500-19 <br />10. ATTACHED DOCUMENTATION (Check all that apply): <br />Revised Scope of Work <br />Revised Financial Plan <br />Other. 2017 Annual Operating and Financial Flan Exhibit A. <br />II, SIGNATURES <br />AMHORT ED R.EPRESEN'I`A'1`Ii1E: By STGNATTJRE BELOW, THE SIGNING PARTIES CERTIFYTHATTLIEY ARE TBE OFFICIAL REPRESEINTATIVES OF <br />THEM RESPECTIVE PA1xTIES AND AUTHORIZED TO ACT IN T1IEIR RESPECTIVE AREAS FOR iVIATTERS RELATED TO THE ABOVE -RE FERENCI D <br />GRAN`I ;/AGREEMENI'. <br />Y SIG 'TtJRE <br />11. A, IITfrf .AS CO17t <br />I I B. DATE <br />11. C. U,S, FOREST SERVICE SIGNATURE 11. D. DATE <br />SIGNED SIGNED <br />SIGKFD <br />- <br />........................ <br />/ <br />(SignatLIW of Signator' Official) <br />(Signature of Signato _-Ufficial) <br />1 L E. NANTE (type or print). <br />11. F. 7AME (type or print): <br />GENE D.A .A <br />MICHAEL R. WILLIAMS <br />I I. G. TTME (type or print): <br />11. TT. `I'I'T`L.E (type or grin#); <br />heiiff, Kiftitas County <br />Forest Supervisor, 0kano - enatehee National forest <br />r . <br />� <br />__ ....�.......-rte... '!�� <br />!....t.'+: � �...�.� .�:�-�+Z�•-.... ._ �� .... ..`�'Y.--�. N.�-�. ...w. . - YMr iii �.•w..�_C.- <br />•� ,{++ �+[�y <br />y4. 77 J� ( Signatory <br />+J 14 ��{d1.4 1.�� V l��ll.�ilJl� �Y1jLECil) <br />.�4..rR •�W -� yY �_I+. .Y .WwY Y _ .��..�.�.. �.w.�•+.� - ... ►fy.f.�..r�iy�� <br />r4. .l...r <br />.: -.s_•. ...� <br />11. K, AME (type sir print), � �.E L. L0 DEFJvflL <br />•GYM ri ••wC�. Y+e .�r .Yi - w�-,.�irr�_nri .. .� . wy Z ..� �f.-..r�.=.wM .mss •-� <br />11. L. TITLE (type or print): Special Agent in Charge <br />12. G&A REVIEW <br />12, A. The authority and format of thi's modification (14 -LE -. 11161' 211-011-NI3) have been reviewed :ind <br />12. B. DATE <br />approved for signatitr by: <br />SIGNED <br />01/13/2017 <br />for <br />DE ETTE M. STOFLETH <br />U,S..1 or•est Service Gm, nts Managernent Specialist <br />Burden Statement <br />According to the Paperviork Reduction Act of 1995. an agency may not conduct or sponsor, and a person is not required to respond to a colleckn of information unless it displays a valid OMB <br />control number. The valid OMB control number for this information collection is 0596-0217. The time required to complete this informagon collection is estimated to average 30 minutes per <br />response, including lire dme for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. <br />The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, dolor, national origin, age, disability, and where applicable, sex, marital <br />status, familial status, parental status, felicgion, sexual vrientaflon, genetic information, polilfcal beliefs, reprisal, or because all or part of an individual's income is derived from any public <br />assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities Lajho require aitematiue means for communicafion of program information (Braille, large print, audiotape, <br />etc.) should contact USDA's TARGET Center at 202-720-2600 (voice and TDD), <br />To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DD 20250-9410 or call toll free (866) 632-9992 (noire). TDD <br />users can contact U SDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer, <br />