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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 /> <br />DSHS Document No. 7560022067 2006 <br /> <br />COUNTY OF TRAVIS <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 />arties thereto now desire to amend such contract attachment(s) as follows: <br />SUMMARY OF TRANSACTION: <br />ATT NO. OIA: RLSS-LOCAL PUBLIC HEALTH SYSTEM <br /> <br />All terms and conditions not hereb amended remain in full force and effect. <br /> <br />EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN. <br /> <br />CITY OF PARIS <br /> <br />Authorized Contracting Entity (type above if different <br />from PERFORMING AGENCY) for and in behalf of: <br /> <br />PERFORMING AGENCY: <br /> <br />RECEIVING AGENCY: <br /> <br />PARIS.LAMAR COUNTY HEALTH DEPARTMENT <br /> <br />DEPARTMENT OF STATE HEALTH SERVICES <br /> <br />By: <br />(Signature of person authorized to sign) <br /> <br />By: <br />(Signature of person authorized to sign) <br /> <br />(Name and Title) <br /> <br />Bob Burnette, Director <br />Client Services Contracting Unit <br />(Name and Title) <br /> <br />Date: <br /> <br />Date: <br /> <br /> <br />By: ,/ <br />(PER 0 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 />