HomeMy WebLinkAboutsignature formInstitution Name:
Agreement Number.
Please type or print the names, titles, and signatures of persons authorized to sign the claim for
reimbursement All authorized signers, authorized representatives, and program cone must be legal
employees of the institution.
City
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
Authorized Signature Form
Miami Department of Parks and Recreatiion
of
04-0899
AUTHORIZED SIGNERS:
Santiago C..Corrada Director
Type of Print Name Type or Print Title
Jose Matas Principal Staff Analyst
Type of Print Name Type or Print Title
Elizabeth Ott
- Type of Print Name
Admin. Assistant III
Type or Print Title
Signa
S igrtature
I cry that the persons above are authorized to sign the claim for reimbursement.
AUTHORIZED REPRESENTATIVE:
Type or Print Name & Title of Authorized Representative
Date si_•' -
Signature of Authorized Representative
Page 1 of 1
12/03
SFSP-E15