S Grant - Agreement Acceptance of Grant Allocation from the Department of Homeland Security State Homeland Security Grant Program

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Reimbursement Funding Or Declination Form For The U.S: Department of Homeland Security (DHS) FY2003 State Homeland Security Grant Program (SHSGP) Orange County The local government may elect to participate in the grant program and receive grant funds or the local government may decline to participate in the grant_program and elect not to receive grant funds. Please sign this form in the space provided indicating whether the local government elects to receive grant funds or declines grant funds. If the local government declines any portion of the grant, the grant funds will be redistributed to other local governments. A. Equipment: Ninety Nine Thous d Six Hundred Seventy Four Dollars ($99674) e local government Accepts Equipment funding. Signature 'the Chair Of the County Commissioners The local government Declines to receive Equipment funding. Signature of the Chair Of the County Commissioners B. Exercises: Sixteen Thousand Six Hundred Ninety Six Dollars ($16696) 'The local government Accepts Exercises funding. Signa of the Chair Of the County Commissioners The local government Declines to receive Exercises funding Signature of the Chair Of the County Commissioners C. Training: Firv'e~'Thousand Two Hundred Fifty Five Dollars ($5255) W ~ ocal government Accepts Training funding Signa a of the Chair Of the County Commissioners The local government Declines to receive Training funding Signature of the Chair Of the County Commissioners DHS FY2003 SHSGP Memorandum of Agreement Annex A: Reimbursement/Declination Form Page 2 of 1