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<br /> <br />DEPARTMENT OF STATE HEALTH SERVICES <br />1100 WEST 49TH STREET <br />AUSTIN, TEXAS 78756-3199 <br /> <br />ST ATE OF TEXAS <br />COUNTY OF TRA VIS <br /> <br />DSHS Document No. 7560022067 2006 <br /> <br />Contract Change Notice No. 04 <br /> <br />The Department of State Health Services, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in <br />writing with PARIS-LAMAR COUNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The <br />. h d' d h h () tll <br /> <br />partIes t ereto now eSlre to amen suc contract aUac ment s as 0 ows: <br />SUMMARY OF TRANSACTION: <br />ATT NO. OIA: RLSS-LOCAL PUBLIC HEALTH SYSTEM <br />All terms and conditions not hereby amended remain in full force and effect. <br />EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN. <br />CITY OF PARIS <br />Authorized Contracting Entity (type above if different <br />from PERFORMING AGENCY) for and in behalf of: <br />PERFORMING AGENCY: RECEIVING AGENCY: <br />PARIS-LAMAR COUNTY HEALTH DEPARTMENT DEPARTMENT OF STATE HEALTH SERVICES <br />By: By: <br />(Signature of person authorized to sign) (Signature of person authorized to sign) <br /> Bob Burnette, Director <br /> Client Services Contracting Unit <br />(Name and Title) (Name and Title) <br />Date: Date: <br />RECOM~ENDED' <br />By: I~ Ihrt~~ / <br />(PERFO MING AGENCY Director, if different <br />from person authorized to sign contract <br /> <br />JC CSCU - Rev. 6/05 <br /> <br />EXHIBIT A- <br /> <br />Cover Page 1 <br />