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S IGN AT UR E AUT H ORI ZATI ON 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 4/12/18 <br />PROJECT DESCRIPTION CONTRACT NUMBER <br />SHSP FFY-17 E18-180 <br />1. AUTHORIZING AUTHORITY <br />SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE <br />~·~ Gene Dana Sheriff 12/31/2018 <br />2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE PRINT OR TYPE NAME TITLE <br />G . Gene Dana Sheriff :. I _____,c'_ <br />- <br />3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT <br />PRINT OR TYPE NAME TITLE <br />Darren Higashiyama Commander <br />Heather Seibert Chief Financial Manager <br />\\NAC-1\VOL 1\HOME\KARENBI .... \WP\SIGNAUTH Rev ised 3/03