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I <br /> <br /> pARTIAL PAYMENT NOTICE: <br />I YEAR AUTHORIZED 1 cJ [~"~ <br /> PROJECT APPROVAL NO.' <br /> ISTATE AID PROJECT NO. <br /> FEDERAL PROJECT NO. <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br /> STATE OF MINNESOTA <br /> DEPARTMENT OF TRANSPORTATION <br /> OFFICE OF FINANCIAL ADMINISTRATION <br /> <br />STATE AID PARTIAL PAYMENT NOTICE AND REQUEST FOR DEPOSIT <br /> PAY TO [~-]City [---] County of ]; '= '"': <br /> <br />,.. 1,..~ <br />199-}US-U1 <br /> <br />FUNDS RELEASED FROM: ILL t" (.',~ ' ':. <br />FUND NO. <br /> <br />AMOUNT $ '~'J 'r'!C ' ' <br /> <br />SAP <br /> <br />FEDERAL FR-~J£CT <br />FORCE ACCOL't;! <br />OTHER <br /> <br />CONTRACT AMOUNT <br /> <br />STATE AID OBLIGATION <br /> <br />ENCUMBERED <br /> <br />95% CONTRACT OBLIGATION <br /> <br />PRELIMINARY ENGINEERING <br /> <br /> .% RIGHT OF WAY <br /> <br />..,7 ,,,~5.5t <br /> <br />TOTAL PAYMENT $ <br /> <br />Request for redeposit (to agency fund) make checks payable to Commissioner of Transportation in accorance with the curren' <br />rules and regulations pertaining to County. City. and Federal aid projects. You are requested to redeposite the sum of $ <br />for use in paying the County or City share of partial estimates, and for advancing the Federal share of such estimate paymen!s <br /> <br />FED. PROJ. NO. ]STATE PROJ. NO. <br /> <br />COUNTY OBLIGATION <br /> <br />REC'D FROM COUNTY <br /> <br />AMT. DUE FROt.' CO. <br /> <br /> FOR STATE TRANSPORTATION USE ONLY <br />A4/_~,~ ~'~L~_'"~.~,.:'.-.//. ____._/V/I~~~~~ ;r,!',ft~?-~. /////O1/__;-.~_?~///$END '.' <br />A4L---- ~O "1' t oo~ /////01/--____///$END <br /> _L/__~-_II ....... -./v//lllll ....... ?? <br /> <br />...... ,.,Jl - CtLy Stat:~ Aid ~c;~:t. <br />A64 /=~ .... _J V / /79000/_'""' '" __/ <br /> Ot//_.-..~ 3_.~. .;:. ,. ,~....:'5 ZIO3O$4 _.//// _/ __//. <br /> <br />I hereby certify that the goods or materials covered <br />by this claim have been inspected and received or the <br />services have been performed, are in accordance with <br />specifications, and are in proper form, kind. amount, <br />and quality, and payment therefore is hereby rec- <br />ommended. <br /> <br />DISTRIBUTION: <br />ORIGINAL -- DEPT. OF FINANCE <br />GREEN COPY - CITY/COUNTY ENGINEER <br />BLUE COPY - CITY CLERK/CO, AUDITOR <br />PINK, COPY -- TRANSPORTAITON FINANCE <br />YELLOW COPIES - TRANSPORTATION FINANCE <br /> <br />TRANSACTION <br /> <br /> APPROVAL FOR ALL ABOVE TRANSACTIONS: <br /> <br />,I,,/ .1:.;'..,. <br />/ ~)ATE AUTHORIZED SIGNt~TU-RE <br /> <br /> (5eq No,) <br />ENC. PRESENT BALANCE -:"~ "~; ' { <br />AMOUNT OF INC. OR (DEC} .......... <br />NEW BAL & AMT~OF ENTRY -7i ,-/:?.; <br /> <br />(Sea <br /> <br />DATE <br /> <br />SI'ATE AID ACCOUNIA' ~ <br /> <br /> <br />