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<br /> <br />LOGIC <br /> <br />ADDITION/DELETION FORM FOR AUTHORIZED REPRESENTATIVES <br /> <br />TAX 10 NUMBER: 74-6001552 <br /> <br />EFFECTIVE DATE: I 0 -Ol~- )cOlo <br /> <br />PARTICIPANT NAME: City of La Porte <br /> <br />PART I: DELETIONS - Please enter the names of the individual(s) to be deletedas Authorized <br />Representatives. <br /> <br />PRINTED NAME PRINTED NAME <br /> <br />1. Cynthia Alexander <br /> <br />3. <br /> <br />2. Lori Langelier <br /> <br />PART": ADDITIONS - Please enter the names of the individual(s) to be added as Authorized <br />Representatives. <br /> <br />Inquiry Only Representative* <br /> <br />PRINTED NAME TITLE SIGNATURE <br /> <br />Phyllis Rinehart <br /> <br />Controller <br /> <br />c;;~ ~~J <br /> <br />PART III: APPROVALS - Please enter the names of all individuals who are currently Authorized <br />Representatives and who authorize the deletions and additions of the individuals above. <br /> <br /> <br />Michael Dolby <br /> <br />Interim Director of Finance <br /> <br />Shelley Wolny <br /> <br />Budget/I nvestment Officer <br /> <br />Page 1 <br />