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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 Sheritrs Office 8/23/17 <br />PROJECT DESCRIPTION CONTRACT NUMBER <br />EMPG FFY-16 E17-156A <br />1. AUTHORIZING AUTHORITY <br />SIGNATURE PRINT OR TYPE NAME TITLEfTERM OF OFFICE <br />&- <br />r <br />"\ Gene Dana Sheriff/12/31/18 <br />....----:- <br />2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE PRINT OR TYPE NAME TITLE <br />/ ~ Gene Dana <br />"-1 . <'"._ <br />Sheriff <br />~ .... <br />3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT <br />~NATURE PRINT OR TYPE NAME TITLE <br />~ 1jL ~ -~ Darren Higashiyama Commander <br />f-"') 1~~ Heather Seibert Chief Financial Manager <br />\\NAC-1\VOL1\HOME\KARENB\ .... IWPISIGNAUTH Revised 3/03