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1. SUBSCRIBER(AGENCY) 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, Name: <br /> such as an opinion of counsel or resolution. (PRINTED) <br /> Name: Signed: <br /> (PRINTED) <br /> Signed: Title: <br /> (with delegated authority) <br /> Title: Date: <br /> (with delegated authority) <br /> Date: 3. COMMISSIONER OF ADMINISTRATION <br /> delegated to Materials Management Division <br /> By: <br /> Name: <br /> (PRINTED) Date: <br /> Signed: 4. COURTS <br /> Authority granted to Bureau of Criminal Apprehension <br /> Title: Name: <br /> (with delegated authority) (PRINTED) <br /> Date: <br /> Signed: <br /> Title: <br /> (with authorized authority) <br /> Date: <br /> 10 <br />