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<br /> <br />Designation of Agent Form <br /> <br />County of Orange <br />As City/ County Manager of _ _ , I designate the following <br />person: <br />Jack Ball <br />Name: <br />Emergency Management Director <br />Title: <br />Address: P..O. Box 8181 <br />City 8t Zip: Hillsborough, 27278 <br />Telephone: 919-968-2050 <br />Fax: <br />919-968-4066 <br />Email: jball~co.orange nc,.us <br />• <br />to be my Designated Agent for the DHS FY2045 HSGP. The above-listed person may sign and <br />submit documents related to this gtan# <br />None <br />Restrictions (If none, write none): _ _!„ <br />NCEM recommends that the County Emergency Manager be identified as the Designated <br />Agent <br />Ci oun ge;:'s Signatiu~e <br />DHS FY2005 HSGP Designation Forms 2 of 3 <br />