Laserfiche WebLink
<br /> Page 5 of 5 pages <br /> assistance or retain possession of any assistance from the <br /> Department. The person or perso~s whose signatures appear below are <br /> authorized to sign this assurance on behalf of the program <br /> applicant." <br />Executed in triplicate originals on the dates indicated. <br /> TEXAS DEPARTI-1ENT OF HEALTH <br />By: By <br />Pr j c Official Empowered and .Rèrmas L. <br /> thorized to Contract Deputy Commissioner <br /> Hanagement and Administration <br />Name f1.C MJf{Z~L[Z <br /> (Print) <br />Official Title~ 1V (fJAJJß ff K <br /> (Print) <br />Date q~ 5-- g~ Date SEP <br /> <br /> Recomnended: <br /> . Clift Price, M.D. <br /> Associate Comnissioner <br /> Personal Health Services <br /> Approved As To Form: <br /> By: <br /> Office of General Counsel <br />