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<br />FINANCIAL STATUS REPORT <br />(Short Form) <br />(follow instructions on the beck) <br />1. Federal Agency end Orgeni zationel Element 2. Federal Grant or Other Identifying Number Assigned pIB Approval Pape 1 of <br />to which Report ie Submitted By Federal ABencY Mo. <br />DEPARTMENT OF INTERIOR,OSM GR090081 0348-0039 1 Pepe <br />3. Recipient Organization (Memo and eanplete address, including ZIP code) <br />Department of Natural Resources <br />Division o} Mined Lard <br />1313 Shermm Street, Room 275 <br />Deriver, Colorado 80203 <br />4. Esployer Identlftestion Nrmber 5. Recipient Aeeount Number or Identlfyirrg Nurber 6. Final Report 7. Besie <br />84-064-4739 PKA 462 NPNP NO Accrual <br />8. Frardirq/Grent Period (See instruetiorrs) 9. Period covered by this Report <br />Frain: (Month, Day, Teer) To; (Month, Day, Tear) Frain: (Month, Day, Yeer) To: (Month, Day, Teer) <br />05/15/90 05/75/93 05/15/90 06/30/91 <br />10. Trernsetioro: I II III <br />e. Total Outlays <br />b. Recipient where of outlays <br />e. Federal share of outlays <br />d. Total unliquideted obi igeti orm <br />e. Reei picot share of unliquideted obliBet ion8 <br />f. Federal share of unliquidated obligations <br />g, Total Federal ehere (Sum of lines c and f) <br />h. Total Federal fords suthori zed for this fulling period <br />Previously This Cumulative <br />Reported Period <br />0.00 4,438.80 <br />0.00 0.00 <br />0,00 4,438.80 <br />4,438.80 <br />0.00 <br />4,438.80 <br />0.00 <br />0.00 <br />0.00 <br />4,438.80 <br />80,000.00 <br />i. UnobliBeted belenca of Federal fords (Line h minor line g) 75,561.20 <br />a. Type of Rate (Piece aR" in appropriate box) <br />Proviai moral Predetermined Final Fixed X <br />11. Indirect b. Rate e. Base d. Total amount e. Federal share <br />Expense 0.06 <br />12: Remarks: Attach awry explenatiorm deemed necessary or informer ion required by Federal sponsoring agency in compliance with <br />governing legislation. <br />13. Certification: I certify to the best of my kno~ledge and belief that this report is correct erd conplete end Chet all outlays <br />and unliquidated obligat(ore are for the purposes set forth in the a~ard documents. <br />Typed or Printed Nerve and Title Telephone (Area code, nunher and extension) <br />Richard J, Ademich, Controller (303) 866-2203 <br />Signature ofl Authorized Certifying 0 i 'al Date Report Submitted• <br />-/ 7 ~ <br />r ~ <br />=-------~`-?l)~~c~rL__""------'~:---= -`---Eli'-~~---- ~--------------------------------------le / =~-~s!--- - - <br />Previous Editions not Usable ,~ Starderd Form 269A (REV 4-88) <br />Prescribed by OMB Circulars A-102 and A-110 <br />