DESIGNATION OF APPLICANT'S AGENT.PDF

ARIZONA DEPARTMENT OF EMERGENCY AND MILITARY AFFAIRS
DESIGNATION OF APPLICANT’S AGENT FORM

The intent of this DESIGNATION is to appoint an APPLICANT’S AGENT for the following:
Select program(s) 4 Public Assistance [| HMA Mitigation Program [| SEC Mitigation
Select duration xX Until further notice LJ Only Event [| From to

Applicant; Maricopa County

CERTIFICATION

;, Paul Penzone duly appointed and_ Sheriff of
(Authorizing Official’s Name) (Title)

Mari copa County , do hereby certify that the information below is true and correct,
(Applicant)

based on a resolution passed and approved (attached) by the Board of Superv Isors
(Governing Body)

of Maricopa County onthe 9th ay og August 2020

(Applicant) (day) (month) (year)

James Prindiville has been designated as the Applicant's Agent
(Name of Designated Applicant's Agent)

to act on behalf of Maricopa County Sheriff's Office
(Applicant)

Sheriff

(Authorizing Official’s Signature) (Title)

This document MUST be accompanied by a copy of the Resolution or Meeting
Minutes by your governing board which designated the Applicant's Agent.

Designated Applicant’s Agent
Name Yames Prindiville

Title/Official Position Chief Financial Officer of MCSO

Full Mailing Address 990 W. Jackson St., Phoenix, AZ 85003

Email Address JamesPrindiville@MCSO.Maricopa.gov

Daytime Telephone Number 602-876-1614 Cel! 602-329-0107

(Please include area code and extension if not a direct number)

| For DEMA Use Only |
March 2020 Form #AZ PA 204-4

Received By:
(initials & Date)