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MN /DOT 30783 <br />STATE OF MINNESOTA <br />DEPARTMENT OF TRANSPORTATION <br />OFFICE OF FINANCIAL ADMINISTRATION <br />STATE AID PARTIAL PAYMENT NOTICE AND REQUEST FOR DEPOSI <br />PARTIAL PAYMENT NOTICE: Pay to Q City ❑ County of <br />1P50 <br />YEAR AUTHORIZED <br />PROJECT APPROVAL NO. - <br />STATEAIDPROJECTNO. „ '�' - �"`` n ' <br />FEDERAL PROJECT NO. <br />CONTRACT AMOUNT - 4 .7 ,0".7..^ <br />• <br />FED. PRO). NO. <br />• <br />DISTRIBUTION: <br />ORIGINAL. <br />GREEN COPY <br />BLUE COPY <br />PINK COPY <br />YELLOW COPIES <br />- DEPT. OF FINANCE <br />- CITY /COUNTY ENGINEER <br />- CITVCLERK /CO. AUDITOR <br />- TRANSPORTATION FINANCE <br />- TRANSPORTATION FINANCE <br />FUNDS RELEASED FROM: 'Urban rrnst.. <br />ACCOUNT NO. <br />FUND NO. <br />90% CONTRACT OBLIGATION <br />PRELIMINARY ENGINEERING <br />•% RIGHT OF WAY <br />4 /L.`i fl2 _ - - _IVI//f/Il <br />4 /17:2 1 _ d_./ 220Y _ll_ ='r2j,xnooa!1- - _IV /NI//I <br />641_a.21'l_`OOl _IV/ 0 4 J-1• t. -_x., r .1 — a <br />01/1_7121 ! "n" °" /_032ZED <br />AMOUNT 543.''.x. <br />STATE AID OBLIGATION <br />ENCUMBERED S <br />3 (x•= <br />3, -1 .7^ <br />Er1 :02 <br />TOTALPAYMENT $ 43,20:1.52 <br />/////01/_719_/// <br />11/I/Olh2_9_I /I <br />/79000/_ inc LO <br />_ /I/l _ =EQg 6 S /1/ <br />(Y) SAP <br />( ) FEDERAL PROJECT <br />( ) <br />FORCE ACCOUNT <br />( ) OTHER <br />4'_• <br />,05%.7 .50 <br />2.104.3& <br />REQUEST FOR REDEPOSIT ITO AGENCY FUND) MAKE CHECKS PAYABLE TO COMMISSIONER OF TRANSPORTATION IN ACCORDANCE WITH TO <br />THE TH RULES AND REGULATIONS PERTAINING USE IN PAYING THE COUNTY OR CITY SHARE R OF E PARTIAL ESTIMAT S, A <br />AND FOR <br />R POSIT THE SUM OF S FOR <br />ADVANCING THE FEDERAL SHARE OF SUCH ESTIMATE PAYMENTS. <br />. COUNTY OBLIGATION I RECD FROM COUNTY AMT. DUE FROM CO. <br />STATE PROJ NO. <br />FOR STATE TRANSPORTATION USE ONLY <br />_1 <br />TRANSACTION <br />SEND / 007 1 50 - r/. 4/7 <br />SEND /c(F - ^ / ? ?/ <br />o cs ✓� <br />ISED. #1 <br />77 <br />54.77 <br />/rifle <br />APPROVAL FOR ALL ABOVE TRANSACTIONS: <br />n r <br />DATE / / AUTHORIZED SIGNATURE <br />DATE STATE AID ACCOUNTANT <br />(SEQ. #1 <br />:.00 <br />ENC. PRESENT BALANCE y <br />AMOUNT OF INC. OR (DEC) ` >1( T: T, "2 <br />NEW BAL. & AMT. OF ENTRY /D . C*D.. z1 n <br />