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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 DATE SUBMITTED <br />Kittitas County; Kittitas County Sheriffs Office I a 1 13 9 /6 <br />PROJECT DESCRIPTION CONTRACT NUMBER <br />EMPG Grant 2016 <br />E17-156 <br />I <br />1. AUTHORIZING AUTHORITY <br />SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE <br />Gene Dana Sheriff / 2019 <br />2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE PRINT OR TYPE NAME TITLE <br />Gene Dana Sheriff <br />3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT <br />SIGNATURE PRINT OR TYPE NAME TITLE <br />Darren Higashiyama Commander <br />Heather Seibert Chief Financial Manager <br />11NAC-lWOLIiHOME1KARENBI....IWP151GNAUTH Revised 3103 m <br />