State of Mississippi, Department of VENDOR NAME Information Technology Services, on behalf of Mississippi Department of Revenue By:________________________________ By:_______________________________ Authorized Signature Authorized Signature Printed Name: Craig P. Orgeron, Ph.D. Printed Name:______________________ Title: Executive Director Title:______________________________ Date: ______________________________ Date:______________________________ EXHIBIT A
State of Mississippi, Department of Information Technology Services, on behalf of Mississippi Department of Revenue VENDOR NAME By:________________________________ By:_______________________________ Authorized Signature Authorized Signature Printed Name: Craig P. Orgeron, Ph.D. Printed Name:______________________ Title: Executive Director Title:______________________________ Date: ______________________________ Date:______________________________ EXHIBIT A
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