HomeMy WebLinkAboutSignature Authorization Form (3)6,*1$785($87+25,=$7,21)250
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION DATE SUBMITTED
PROJECT DESCRIPTION
Public Assistance Program, Disaster -DR-WA
CONTRACT NUMBER
1. AUTHORIZING AUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE
2. OTHER INDIVIDUALS AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE PRINT OR TYPE NAME TITLE
SIGNAUTH – PA, Revised 11/09
County of Kittitas September 1, 2020
4481-DR-WA D20-189
Brett Wachsmith Chairman, Board Co Commissioners
Laura Osiadacz Vice-Chairman Board Co Commissioners
Cory Wright Co Commissioner
Judy Pless Budget & Finance Manager
Jerry Pettit County Auditor