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SIGN ATU RE 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 l I /16 (ri <br />PROJECT DESCRIPTION CONTRACT NUMBER <br />18 SHSP Homeland Security E19-111 <br />1. AUTHORIZING AUTHORITY <br />SIGNATURE PRINT OR TYPE NAME TITLEfTERM OF OFFICE <br />0-\) Gene Dana Sheriff/ 12/31/18 <br />2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE PRINT OR TYPE NAME TITLE <br />~Q_ Gene Dana Sheriff <br />3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT <br />-SIG ~TURE PRINT OR TYPE NAME TITLE <br />/J )r 1/h ' -Darren Higashiyama Commander <br />---I.... -v ') r\~ ~~----Kim Dawson Sheriff Admin <br />\\NAC-1\VOL 1\HOME\KARENB\ .... \WP\SIGNAUTH Revised 3/03