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14 <br />Designation of Agent Form <br />As the County Manager of <br />following person: <br />Name: <br />Title: <br />Address: <br />City & Zip: _ <br />Phone: <br />Fax: <br />E-mail <br />I appoint the <br />to be my Designated Agent for the DHS FY2003 SHSGP. The above-listed person may sign and <br />submit documents related to this grant. <br />Restrictions (If none, write none): <br />County Manager's Signature Date <br />NCEM recommends that the County Emergency Manager <br />be identified as the Designated Agent. <br />This form must be returned to the DHS FY2003 SHSGP Manager no later than August 29, <br />2003. <br />DHS FY2003 SHSGP Memorandum of Agreement Annex B: Designated Agent and POC Page 2 of 5 <br />