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STATE OF MINNESOTA <br /> DEPARTMENT OF TRANSPORTATION /o~ ~L~ "o <br /> ACCOUNTING AND FINANCE SECTION IS ~ ~ '~ <br /> FINAL STATE AID PAYMENT NOTICE AND REQUEST FOR D~,P.~.SIT ~ ~ , <br />FINAL PAYMENT NOTICE: Pay to [] City [] County of <br /> <br />PROJECT APPROVAL NO. !'~h YEAR <br />STATE AID PROJECT NO. <br />FEDERAL PROJECT NO. <br />PROJECT MILES BRIDGE MISC. <br /> <br />FUNDS RELEASED FROM: <br />ACCOUNTNO. <br />FbNB NO. <br /> AMOUNT S <br /> <br />?= <br /> <br />SAP <br />FEDERAL PROJECT <br />FORCE ACCOUNT <br />OTHER <br /> <br />FINAL ACCEPTANCE <br /> <br /> -.'. -17- F _~ <br />CITY OR COUNTY ENGINEER <br /> <br />ENCUMB. LIQUID. <br />DISBURSEMENT <br />INC. DEC. BAL. <br /> <br />:ONSTRUCTION COSTS <br />:0Nq~T (NET) <br />'RELIMINARY ENGINEERING <br />;ONSTRUCTION ENGINEERING <br /> <br />TOTAI~ ANTICIPATED COUNTY <br /> FEDERAL FUNDS OBLIGATION <br /> <br />TOTALS <br />LESS PARTIAL RELEASES -SCH. NOS. <br />FINAL PAYMENT DUE FROM STATE AIO FUNDS <br />AMOUNT AVAILABLE IN ALLOTMENT AND PAID <br /> <br />REQUEST FOR REDEPOSIT (TO AGENCY FUND} MAKE CHECKS PAYABLE TO COMMISSIONER OF TRANSPORTATION IN ACCORDANCE <br />WITH THE CURRENT RULES AND REGULATIONS PERTAINING TO COUNTY; CITY, AND FEDERAL AID PROJECTS. YOU ARE REQUESTED <br />TO REDEPOSIT THE SUM OF $ ' : .FOR USE IN PAYING THE COUNTY OR CITY SNARE OF PARTIAL ESTIMATES, AND <br />FOR ADVANCING THE FEDERAL SHARE OF SUCH ESTIMATE PAYMENTS. <br /> 'ROJ. NO. STATE PROJ. NO. ' COUNTY OBLIGATION REC'O FROM COUNTY I ' AMT. DUE FROM CO. <br /> I <br /> .,.-.. ~::.: ~': ,.'~ , -- . <br /> <br /> · · · FOR DEPARTMENT OF TRANSPORTATION USE ONLY <br /> <br />I I ...... IJ ..... . ~../1_ _ _ :._ .~ ~ _ .~ _ -/v/Il~IH 1/111011_ _ _./11 SEND <br />I I ..... J_l .... .~/ .......... _./Vl/////I /ll//OIl_ _- _JII SEND <br />641 ......... _/VI - 179000/_._'_ _ ~/ <br /> 0111_ _ J I ..... _lIll ....... _ _111 <br />G4/_ _ _0482~_ _/VI rt{~ .q~-.,~t-.~ ~-Irl ("x-~q~c. /790001_ 2.%4~1 I" <br /> 0111_7123 I_ ~5268.l _111/_ ~(2~)_ _111 ..... <br /> <br /> )ISTRIBUTION: <br />ORIGINAL <br />GREEN COPY <br />BLUE COPY <br />PIN K COPY <br />Y£LLOWCOPIES -- Mn/DOTFINANC~ <br /> <br />-- DEPT. OF FINANCE <br />-- CITY/COUNTY ENGINEER <br />--.' CITY CLERK/CO. AUDITOR <br />-- Mn/DOT FINANCE . <br /> <br />APPROVAL <br /> <br />TRANSACTION <br /> <br />ENC. PRESENT BALANCE <br />AMOUNT OF INC. OR IDEC~ <br />NEW BAL & A~T. OF ENTRY <br /> <br />DATE <br /> <br />STATE AID ACCOUNTANT <br /> <br /> <br />