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,,_s <br /> .a <br /> t <br /> OREGON WATERSHED ENHANCEMENT BOARD <br /> RE VEST FOR RELEASE OF FUNDS <br /> Q <br /> 'i Grantee Name: ~ ~"~-y b -F ~ u~l. <br /> Grantee'sFiscalAgent: ~ ;-f'.G n c~ro.~3 1~1©1 E: l,u~ wlus¢ 1~ uln'~^ <br /> Project Number: ~ b ~ ~ 3 Project Name: C ,e, L a.,, c <br /> ~ ~ <br /> In accordance with the terms of the Grant Agreement, I request funds as follows: <br /> <br /> I <br /> Payment Request Number OR Final Request <br /> I understand that I will need to send receipts /invoices and spreadsheet to document expenses for funds <br /> previously received from OWEB for this project, before any future Request for Release of Funds will be <br /> processed. <br /> <br /> r <br /> Note: All checks will be made payable to Grantee's Fiscal Agent. Grantee and Fiscal Agent are responsible for <br /> paying vendors directly with funds received for this project. <br /> TOTAL of All Amounts <br /> Budget Category Previously Requested Amount this Request <br /> 1. ~ac ~c~,~:s;-~:b~ $ O~ $ ~ao~ pOO ` pp <br /> 2. $ $ <br /> 3. $ $ <br /> 4. $ $ <br /> 5. $ $ <br /> 6. $ $ <br /> 7. $ $ <br /> 8. $ $ <br /> 9. $ $ <br /> 10. $ $ <br /> Totals $ $ ~o ~ 000. too <br /> I declare that this statement is, to the best of my knowledge, true, correct and complete. <br /> Grantee's Authorized Signature: Date: 7~a/"0~-- <br /> Grantee Contact Phone Number on billing questio . ~5Y/ ) 6 ~a - l <br /> f $ g g <br /> Grantee Contact E-mail Address: e~/ Cr /1. 1t~0~~ ~ C.; e~~,4 ~T ~.c S <br /> Forward This Request to OWEB's Regional Project Manager for Signature Below <br /> I find this request to be consistent with the Grant Agreement and all funding conditions have been met. <br /> OWEB Project Manager: Date: <br /> F:/OWEB/Forms/Grant Billing Instructions.doc ~3~ <br /> A/O 01-01-02 <br /> <br />