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<br />FINANCIAL STATUS REPORT <br />(Short Form) <br /> (follow instructions on the back) <br />1. Federal Agency and Organizational Element 2. Federal Grant or Other Identifying Number Assigned OMB Approval Page 1 of <br />to which Report is Submitted By Federal Agency No. <br />DEPARTXENT OF INTERIOR,OSX GR090081 0348-0039 1 Pege <br />3. Recipient Organization (Name and complete address, including ZIP code) <br />Department of Natural Resources <br />Division of Mined Land <br />1313 Sherman Street, Roam 215 <br />Denver, Colorado 80203 <br />4. Employer Identification Number 5. Recipi en[ Account Number or Identifying Nunber 6. Final Report 7. Basis <br />84-064-4739 PKA 462 NPNP YES Aeerual <br />8. Funding/Grant Period (See instructions) 9. Period Covered by this Report <br />From: (Month, Day, Tear) To: (Month, Day, Year) Fran: (NOnth, Day, Year) To: (Month, Day, Year) <br />05/15/90 05/15/93 12/37/91 06/30/92 <br />10. Transactions: I I[ fII <br /> Previously This Clmilative <br /> Reported Period <br />a. Total Outlays 67,373.49 15,886.51 83,260.00 <br />b. Recipient share of outlays 0.00 0.00 0.00 <br />c. Federal share of outlays 67,373.49 15,886.51 83,260.00 <br />d. Total unliquidated obligations <br />e. Recipient share of unliquidat ed obligations <br />f. Federal share of unliquidated obligations <br />g. Total Federal share (Sun of lines c and f) <br />h. Total Federal funds authprized for Ch is funding period <br />i. Unobligated balance of Federal funds (Line h minus line g) <br />a. Type of Rate (Place "%" in appropriate box) <br />Provisional Predetermined <br />11. Indirect b. Rate c. Base d. Total amount <br />Expense 0.06 <br />0.00 <br />-..-.......-'-•---- <br />0.00 <br />..............°--- <br />0.00 <br />83,260.00 <br />83,260.00 <br />0.00 <br />Final Fixed K <br />e. Federal share <br />12. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in carpliance with <br />governing legislation. <br />13. Certification: I certify to the best of my knowledge and belief that this report is correct and coop fete and that all outlays <br />and unliquidat ed obligations are for the purposes set forth in the award documents. <br />typed or Printed Name and Title Telephone (Area code, nuniher and extension) <br />Richard J. Adamich, Controller (303) 866-2203 <br />Signature. of Authorized Certifying Official Date Report Submitted: <br />~ i <br />/ ~JC <br />Previous Editions not Usable Standard Form 269A (REY 4-88) <br />Prescribed by OMB Circulars A-702 end A-170 <br />~1 ' <br />