HomeMy WebLinkAboutSignature Authorization FormSIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray,Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION DATE SUBMITTED
Kittitas,County of June 16,2020
PROJECT DESCRIPTION CONTRACT NUMBER
Fire Management Assistance Grant Program,·FM-5253-WA D19-1004
1.AUTHORIZINGAUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLEITERMOF OFFICE
Brett Wachsmith County Commissioner
Laura Osiadacz County Commissioner
Cory Wright County Commissioner
2.OTHER INDIVIDUALS AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE PRINT OR TYPE NAME TITLE
Judy Pless Budget Finance Manager
Jerry Pettit County Auditor
SIGNAUTH -PA,Revised 11/09