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1. SUBSCRIBER (AGENCY) <br />2. DEPARTMENT OF PUBLIC SAFETY, <br />BUREAU OF CRIMINAL APPREHENSION <br />Subscriber must attach written verification of <br />authority to sign on behalf of and bind the entity, <br />Name: <br />such as an opinion of counsel or resolution. <br />(PRINTED) <br />Name: <br />Signed: <br />(PRINTED) <br />Signed: <br />Title: <br />(with delegated authority) <br />Title: <br />Date: <br />(with delegated authority) <br />Date: <br />3. COMMISSIONER OF ADMINISTRATION <br />delegated to Materials Management Division <br />By: <br />Name: <br />Date: <br />(PRINTED) <br />Signed: <br />4. COURTS <br />Authority granted to Bureau of Criminal Apprehension <br />Title: <br />Name: <br />(with delegated authority) <br />(PRINTED) <br />Date: <br />Signed: <br />Title: <br />(with authorized authority) <br />Date: <br />10 <br />Page 65 of 104 <br />