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<br />000245
<br />
<br /> OUTLAY REPORT AND REQUEST FOR ,. F.a..al AI.n~r Qnd O'lonllo';o"ol 11. F.d.'ol Granl No. O' O'~..
<br /> Elom.nt 1..n,;fyi"IHu..b..
<br />REIMBURSEMENT FOR CONSTRUCTION PROGRAMS
<br />3. Typo.fR.qu..' ,. Bo".oIR.qu..' , P.";aIPa,...n.R........'......
<br /> [J F'nol OC..~
<br /> DP."iol O....,e.uodE.o"n"..u'.
<br />.. E..oloy.r Idon,;l,ca';on No. , G'On'" Accoun' No. D.ld.n'H""1 .. P."odC",",.<lIMon,h.Do.. Too,)
<br /> ,.. FIWM I"
<br /> I I I I
<br />9. H","" of Gran'.. Q'lon;'''',on " No",. 01 Po,..(II.W.,..n' ,."n h.", 9)
<br /> '''UTOO. ...0..... "."'.0. ..0 .A~'
<br /> "" .,..T, "0 coO< C'" 0'''' ".'000
<br /> ". STATUS OF FUNDS
<br /> P~OGR.!olS - FUHCT'ON5 - .o.CTIVIT'ES
<br /> CLASSIFICATION '" '" '"
<br /> TOTAL
<br />,. Admlnlslrallveexpense. , . , .
<br />b. Preliminary expense .
<br />, Land,slruclmes, right-ol.way
<br />d. Architectural engineering DaSIC fees.
<br />.. Other archlleclural engineellng fees.
<br />f. Projeclms~cllonfees . ....
<br />, Lanildevelopmenl .....
<br />h. Relocalion e~pense.
<br />; Relocali{l\piIymenlstolndiv. anilb\lsmesses
<br />I. DemolitIOn anillemoval . --
<br />k. Construclloo and project Impl"ovemenlcosl..
<br />I. EQul~enl
<br />m.Mlscellaneouscosl.
<br />" Tolal cumulallveto ilate (SlIII 01 Lines a-m)
<br />P. Deilucllonslol program Income.
<br />p. Nelcumulaflve loilale (line n mInus Line 0).
<br />p. Feilelal share loilale
<br />,. Rehabil1lallon granls (IOI}\ leimbursement)
<br />,. Tolal Feileral share (Sum 01 Lines Qanilr).
<br />I. Feileral paymenls plevlously requcsleil.
<br />.. Amounl reQuesleillor lelmbursemenl. , . I .
<br />.. Percenl a! proleclcompleteil . . . .
<br />". CERTIFICATION _I c.",I. .ha"a ,ha b.,' "r",y kno..I.dga ~dbalo.flh. blll.oc".".fd,.bu...",.n.. o,.,nac<o'd.nc...I,h '0.1.,,,,. of .h.p,o,.e'
<br /> 0"' Iho' .h. ,.."'bu,.....", '.p,...n" ,~. F.d.,.I .h.,. o~. .,h'c~ ho. n,' b..n p"",,,u.l. ,.quOl'.' <>"td tho. <>"t 'nop.<'lan 00. ba.n a.,/o,...d 0"0 011
<br /> ..o'~ I. .n aeeo'.ane. .."h .h. '.''''' at Ih. gran'.
<br /> ,. GRAN1EE .. SUTE. LOCAL. 0' FEOERAL GOVERNMENT liE P RE~EN TAliI' E
<br />No"" N.",.
<br />T,'I. T.lap~o". No. Till. hl.poon.No.
<br />~'gn.IU'. of A",hod I.d Olf". 01 Do'. 5IQna''''. or A~.h."..d Orl.e;ol Do'.
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