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SIGNATURE AUTHORIZATION FORM <br />WASHINGTON STATE MILITARY DEPARTMENT <br />Camp Murray, Washington 98430-5122 <br />Please read instructions on reverse side before completing this form. <br />NAME OF ORGANIZATION <br />DATE SUBMITTED <br />Kittitas County Sheriffs Office <br />8/23/17 <br />PROJECT DESCRIPTION <br />CONTRACT NUMBER <br />EMPG F'FY-16 <br />E17 -156A <br />1. AUTHORIZING AUTHORITY <br />SIGNATURE <br />PRINT OR TYPE NAME <br />TITLE/TERM OF OFFICE <br />Gene Dana <br />Sheriff/ 12/31/18 <br />Heather Seibert <br />Chief Financial Manager <br />2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE <br />PRINT OR TYPE NAME <br />TITLE <br />Gene Dana <br />Sheriff <br />Heather Seibert <br />Chief Financial Manager <br />3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT <br />54qNATURE <br />PRINT OR TYPE NAME <br />TITLE <br />Darren Higashiyama <br />Commander <br />Heather Seibert <br />Chief Financial Manager <br />MAC-1WOL1\HOMEIKAREW.... 1 MIGNAUTH Revised 3/03 <br />