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<br />Health Savings Account (HSA) Authorized Signature List <br /> <br /> <br />The persons listed below are authorized by your company to provide direction to Wells Fargo <br />regarding your company'sHSA plan. <br /> <br />Company Infonnation <br /> <br />Citv of Centerville <br /> <br />I ~e <br /> <br />Company Name <br /> <br />List <br />Name Tille Signature <br />Dallas Larson Administrator X <br />Name nle Signature <br />John Meyer Finance Director <br />Name Tille Signature <br />Mary Capra Mavor <br />Name nle Signature <br /> <br />The _ signatures wr~ten above are the signatures of the person holding the t~le(s) indicated. <br /> <br />Signature of Authorized Official <br /> <br />City of Centerville <br />Name 0/ Company 01 Institution <br /> <br />Date <br /> <br />HSA-ASL <br />311512006 <br /> <br />&!- <br />