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TEXAS DEPARTMENT OF HEALTH <br />1100 WEST 49TH STREET <br />AUSTIN, TEXAS 78756 -3199 <br />STATE OF TEXAS <br />COUNTY OF TRAVIS <br />474 <br />TDH Document No. 7560022067 2004 <br />Contract Change Notice No. 03 <br />The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in writing <br />with PARIS -LAMAR COUNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties thereto <br />now desire to amend such contract attachment(s) as follows: <br />SUMMARY OF TRANSACTION: <br />ATT NO. 01A : AC FAM. HEALTH - PRIMARY HEALTH CARE <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: <br />PARIS -LAMAR COUNTY HEALTH DEPARTMENT <br />By: <br />(Signature of person authorized to sign) <br />(Name and Title) <br />Date: <br />By: <br />(PE MI GAG NCX �edstr;�n( <br />from uerson authoriz <br />RECEIVING AGENCY: <br />TEXAS DEPARTMENT OF HEALTH <br />By: <br />(S ign a ture of person uthorized to sign <br />Bob Burnette, Director <br />Procurement and Contracting Services Division <br />(Name and Title) <br />Date: n I- R `aapy <br />Cover Page 1 <br />EXHIBIT <br />SC PCSD - Rev. 2/03 <br />