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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 I DATE SUBMITTED <br />KITTITAS COUNTY I JANUARY 3, 2017 <br />PROJECT DESCRIPTION CONTRACT NUMBER <br />FEMA HAZARD MITIGATION PLANNING GRANT HMP #E17-062 <br />1. AUTHORIZING AUTHORITY <br />SIGNATURE <br />PRINT OR TYPE NAME <br />TITLE/TERM OF OFFICE <br />OBIE O'BRIEN <br />COMMISSIONER <br />�Ct`4b l vY� <br />PAUL JEWELL <br />COMMISSIONER <br />LAURA OSIADACZ <br />COMMISSIONER <br />2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE <br />PRINT OR TYPE NAME <br />TITLE <br />MARK COOK <br />DIRECTOR PUBLIC WORKS <br />�Ct`4b l vY� <br />KATHY JURGENS <br />PW FINANCE SYSTEM MGR <br />3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT <br />SIGNATURE <br />PRINT OR TYPE NAME <br />TITLE <br />MARK COOK <br />DIRECTOR PUBLIC WORKS <br />KATHY JURGENS <br />PW FINANCE SYSTEM MGR <br />\\NAC-1\VOL7\HOME\KARENB\.... MMSIGNAUTH Revised 3/03 <br />