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<br />~~~~~ ~ <br />FINANCIAL STATUS REP00.T <br />(Short Form) <br />(follow instructions an the beck) <br />1. Federal Agercy and Organi zationel Element 2. Federal Grant or Other Identifying Number Assigned qIB Approval Page 1 of <br />to which Report is Submitted 8y Federal Agency No. <br />DEPARTMENT OF INTERIOR,OSM GR090081 0348-0039 1 Page <br />3. Recipient Organization (Name erd camp( ate address, including ZIP code) <br />Department of Natural Resources <br />Division of Mined Lard <br />1313 Sherman Street, Roan 215 <br />Darner, Colorado 80203 <br />4. Enplayer ]dente( iestion NwEer 5. Recipient Account Number or Identifying Number 6. Final Report 7. Basis <br />84-064-4739 PKA 662 MPNP NO Aeeruel <br />8. Funding/Grant Period (See instructions) 9. Period Covered by this Report <br />Fran: (Mmth, Dey, Yeer) To: (Month, Day, Year) Fram: (Month, Dey, Year) io: (Month, Day, Year) <br />05/15/90 05/15/93 06/30/91 09/30/91 <br />10. Traroact tore: I 11 III <br />e. Totsl Outlays <br />b. Recipient share of outlays <br />c. Federal share of outlays <br />d. Total unliquidated obligeii orv <br />e. Recipient share of unliquidated obligations <br />f. Federal share of unliquidated obligations <br />Previously Th ie Cumilative <br />Reported Period <br />4,438.80 61,465.00 65,903.80 <br />0.00 0.00 0.00 <br />4,438.80 61,465.00 65,903.80 <br />0.00 <br />0.00 <br />0.00 <br />g. Total Federal share (Sum of lines c and f) 65,903.80 <br />h. Total Federal funds authorized for th (e }ending period 80,000.00 <br />i. UrabliBated balance of Federal funds (L(ne h mi rnis floe g) 14,096.20 <br />a. Type of Rate (Place "X" in appropriate box) <br />Provisional Predetermined Final Fixed X <br />11. Irdlreet b. Rate e. Base d. Total amount e. Federal share <br />Expense 0.06 <br />12. Remarks: Attach arty explanations deemed necessary or information required by Federal sponsoring agency in compliance with <br />governing lepislat ion. <br />13. Certification: I certify to the best of mY knowledge and belief that this report is correct and carrQlete and that ail outlays <br />and unliquidated obligati ors are for the purposes set forth in the award documents. <br />Typed or Printed Neme and Title Telephone (Area code, number and extension) <br />Richard J. Adamich, Controller (303) 866.2203 <br />Signeture~ fAUthorized Certjfyirg ) i t Date Report Submitted: <br />f / ~, l <br />Previous Editions not Usable ~ Standard Form 269A (REV 4-88) <br />Prescribed by OM8 Circulars A-102 and A-110 <br />