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<br />I <br /> <br />I <br /> <br />I <br /> <br />OAG-CRIME-VICTIM-SERVI Fax:51247675265 <br /> <br />Oct 12 2004 15:34 <br /> <br />P.CE <br /> <br />0/"<1111 Nim,bl'r' fl4G0-1240AJ <br />"~l1"':v l\'urIIlt: San ,\!{at'c'ls Police [)fip<li'"lmll"t <br /> <br />Note 011 Desie;n>>.ted OfficialH: No_two officials may be the !lame pefson. It is the responsibility ofthc grBntec to notify the <br />DAG of any ehanses in grant offlciak The Authorized Signatory ligns lhe llcc~tan'e notices. !hI< contact information for <br />the grant contact needs to be f1l1ed out below, but the grant contact does not sip the acceptance noti~. <br /> <br />SIGNATURE of Autborized SigDlltory <br /> <br />Name (PrInted) <br /> <br />TItle (PrintC'4) <br /> <br />Address <br /> <br />City, State, Zip <br /> <br />Phone Number with area code <br /> <br />Fax Number with AtCl Code <br /> <br />E.mailllddrcss <br /> <br />PLEASE FiLL OUT THE FOLLOWING INFORMATION FOR THE GRANT CONTACT, THE GRANT CONTACT <br />DOES NOT SIGN TIlE ACCEPTANCE NOTICE. <br /> <br />CRANT CQNTACT: <br /> <br />Orant Contact Name <br /> <br />Title of Grant Contact <br /> <br />Address <br /> <br />City, State; Zip <br /> <br />Phone: Number with atlloll code <br /> <br />Fax Nwnber with arC8 coclc <br /> <br />E.mall address <br />