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io <br />Designation of Agent Form <br />As County Manager of , I designate the Following <br />person: <br />Name: <br />Title: <br />Address: <br />City & Zip: <br />Telephone: <br />Fax: <br />Email: <br />to be my Designated Agent for the DHS FY2004 SHSGP. The above-listed person may sign and <br />submit documents related to this grant. <br />Restrictions (If none, write none): <br />NCEM recommends that the County Emergency Manager be identified as the Designated <br />Agent. <br />DHS FY2004 SHSGP Annex B: Subgrant Forms 2 of 7 <br />