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~ · STATE OF MINNESOTA <br /> " DEPAnTMENT OF TFIANSPOnTATION <br /> OFFICE'OF FINANCIAL ADMINISTRATION <br /> <br /> m STATE AID PARTIAL PAYMENT NOTICE AND REQUEST FOR DEPOSIT <br /> <br /> PARTIAL PAYMENT NOTICE: Pay to [] City ~-1 Coupty of <br /> ! , <br /> <br /> mYEAR AUTHORIZED <br /> ~ROJECT APPROVAL NO. <br /> · STATE AID PROJECT NO. <br />JFEOERAL PROJECT NO. <br /> <br />.1 9,$3 <br /> <br />FUNDS RELEASED FROM: <br />ACCOUNT NO. <br />FUND NO. <br /> <br />SAP <br />FEDERAL PROJECT <br />FORCE ACCOUNT <br />OTHER <br /> <br />.ICONTRAC'FAMOUNT <br /> <br />1£.5,293..$5 <br /> <br />I <br />I <br />I <br /> <br />90% CONTRACT OBLIGATION <br />PRELIMINARy ENGINEERING <br /> <br />% RIGHT OF WAY <br /> <br />STATE AID OBLIGATION <br /> <br /> ENCUMBERED <br />109. !37.9CJ <br /> <br />TOTAL PAYMENT $ <br /> <br />116.5£2.25 <br /> <br />mEQUEST FOR REDEPOSITITO AGENCY FUND} MAKE CHECKS PAYABLE TO COMMISSIONER OF TRANSPORTATION IN ACCORDANCE WITH <br /> <br /> THE CURRENT RULES AND REGULATIONS PERTAINING TO COUNTY, CITY, AND FEDERAL AID PROJECTS. YOU ARE REQUESTED TO <br /> <br />[ DEPOSIT THE SUM OF $ .FOR USE IN PAYING THE COUNTY OR CITY SHARE OF PARTIAL ESTIMATES, AND FOR <br />VANCING THE FEDERAL SHARE OF SUCH ESTIMATE PAYMENTS. <br /> <br /> FED. PROJ. NO. STATE PROJ NO. COUNTY OBLIGATION REC'D FROM COUNTY AMT. DUE FROM CO. <br /> <br />'4 <br /> <br />FOR STATE TRANSPORTATION USE ONLY <br /> <br />m <br /> <br />m <br /> <br />Jl' R IBUTION: <br /> <br /> GINAL <br /> <br />GREEN COPY <br /> <br />F,E COPY <br /> COPY <br /> <br /> LOW COPIES <br /> <br />DEPT. OF FINANCE <br />CITY/COUNTY ENGINEER <br />CITYCLERK/CO. AUDITOR <br />TRANSPORTATION FINANCE <br />I RANSPOR TATION FINANCE <br /> <br />_/W/II/ll <br />_lVlllllll <br /> <br />TRANSACTION <br /> <br /> IIII1011_ _ _111 SEND <br /> IIII1011_ _ _ill SEND <br /> . /79000L.?-,,: '- 5 _/ <br />_1111_ _111 <br /> <br /> APPROVAL FOR ALL ABOVE.TRANSACTIONS:- / <br /> /' , ,.,: ,~,' <._/- / <br /> <br /> / DATE <br /> / <br /> <br />ENC. PRESENT BALANCE <br />AMOUNT OF INC. OR (DEC) <br />NEW BAL. & AMT. OF ENTRY <br /> <br />AUTHORIZEOSIGNATURE <br /> <br />~SEO. ~ mED. ~h <br /> <br />DATE STATE AID ACCOUNTANT <br /> <br /> <br />