HomeMy WebLinkAboutSignature Authorization form signedSIGNATURE AUTHORIZATION FORM (SAF)
WASHINGTON MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on page 2 before completing this form.
NAME OF ORGANIZATION
Kittitas County
DATE SUBMITTED
GRANT PROGRAM - Acronyms Accepted
24EMPG
AGREEMENT NUMBER(S)
E26-254
1. AUTHORIZING AUTHORITY
PHYSICAL SIGNATURE
E-SIGNATURE
PRINT OR
TYPE NAME
TITLE & TERM OF OFFICE
(If applicable)
Clay Myers
Sheriff/December 2026
2. AUTHORIZED TO SIGN AGREEMENTS / AMENDMENTS
PHYSICAL SIGNATURE
E-SIGNATURE
PRINT OR
TYPE NAME
TITLE & TERM OF OFFICE
(If applicable)
Clay Myers
Sheriff/December 2026
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
HYSICAL SIGNATURE
E-SIGNATURE
PRINT OR
TYPE NAME
TITLE & TERM OF OFFICE
(If applicable)
W14ANancy
Shaff
Chief Administrative Deputy
s
Darren Higashiyama
Chief Deputy
SAF Revised 5/8/2024
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