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SAMPLE <br />Designation of a Point of Contact Form <br />As County Manager of Cazolina , I designate the following person: <br />Name: Bill Withers <br />Title: Assistant Deput~Sheriff <br />Address: 1 County Place <br />City & Zip: Sandersonville NC 27999 <br />Telephone: 919/555-1234 <br />gam; 919/555-1743 <br />Email: bwithers,~a nc cc orp <br />to be the point of contact for all day-to-day communications for this grant program. The Point of <br />Contact will handle all routine communications with NCEM regazding the status of the grant <br />program. <br />_ 9Vlary Tones 8/7/03 <br />County Manager's Signature Date <br />NCEM recommends that the County Emergency Manager <br />or other staff person be identified as the Point of Contact. <br />17 <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 5 of 5 <br />