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is <br />Designation of Agent Form <br /> <br />County of Orange <br />As City/ County Manager of <br />person: <br /> Jack Ball <br />Name: <br />Title: <br />Emergency Management Director <br /> P,O, Box 8181 <br />Address: <br />City & Zip: Hillsborough, 27278 <br /> <br />Telephone: 919-968-2050 <br />-.- <br /> 919-968-4066 <br />Fax: - <br />Email: lball@co,orange.nc.us <br />I designate the following <br />• <br />to be my Designated Agent for the DHS'FY2005 HSGP The above-listed person may sign and <br />submit documents zelated to this grant <br />None <br />Reshictions (If none, write none): <br />NCEM recommends that the County Emergency Manager be identified as the Designated <br />Agent. <br />City/County Manager's Signature <br />DFIS FY2005 FISGP Designation Forms Z of 3 <br />