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Customer <br /> Name of Entity (must be legal entity name)* Microsoft Licensing , GP <br /> Indian Riveounty BOCC <br /> Signature * Signature <br /> . Printed F I in t ndLa t Name*aeph g4fl ; Printed First and Last Name <br /> Printed Title burn`y dlminlstr6L+ 0r Printed Title <br /> Signature Date* — � (� . �3 Signature Date <br /> (date Microsoft Affiliate countersigns) <br /> Effective Date <br /> Tax ID <br /> (may be different than Microsoft's signature date) <br /> * indicates required field <br /> Optional 2nd Customer signature or Outsourcer signature (if applicable) <br /> OutsourcerCustomer <br /> Name of Entity (must be legal entity name)* Name of Entity ( must be ' legalk entity name)* <br /> � a <br /> * St na"tore* <br /> Signature ' g <br /> . .._ Wa <br /> Printed First and Last Name . 'Prmted �First and Last Name* . <br /> y <br /> Printed Title % � Printed Title* r � ' <br /> Signature Date* Signature DateC <br /> z � <br /> If Customer requires physical media, additional contacts , or is " reporting ;multiple previous Enrollments , <br /> include the appropriate form ( s) with this signature form . If no, media formJs included , no physical media <br /> will be sent <br /> :"ELM <br /> After this signature form is signed by the < Customer, send it and the ContractDocuments to Customer's <br /> chahn partner or Microsoft account manager, >who "must submit them to atieV , 11 . 1*following address When <br /> F t <br /> the�signatun form is, fully e%xecuted byMicrosoft, Customer will receive a confirmation copy <br /> Microsoft Licensing, GP <br /> Dept. 551 , Volume Licensing <br /> 6100 Neil Road , Suite 210 <br /> Reno, Nevada 89511 - 1137 <br /> USA <br /> Prepared By : <br /> APPROVED AS TO FORM <br /> AND LEGAL SUF NCY <br /> PPROVED : <br /> BY <br /> • ALOM S. PQgA8KW1CH <br /> unty Ad inistrator 1.2rOUNTYATTORNEY <br /> ProgramSignForm(MSSign)(NA, LatAm)ExBRA, MLI (ENG)(Oct2011 ) Page 2 of 2 <br /> I <br />