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OREGON WATERSHED ENHANCEMENT BOARD <br /> REQUEST FOR RELEASE OF FUNDS <br /> ~ Grantee Name: ~ r~~-y b ~ ~~,,~-ems <br /> Grantee's Fiscal Agent: C L d coo ~ ~ ~ ~ ti r~ ut~ 1~ e.! r~'~- <br /> ~ ~1~3 e~.t:% <br /> Project Number: r~ - ij 3 Project Name: ~i.S~ <br /> f ~~,,~.t~ ~,J+~`~'j~,,,,~~ ~a,,~ c~~:~, <br /> In accordance with the terms of the Grant Agreement, I request funds as follows: <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 /> <br /> ~ processed. <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 /> Dud~et Category Previously Requested Amount this Request <br /> 2. ~ ~ <br /> 3_ _ - _ _ _ $ <br /> 4. ~ <br /> 6. $ $ <br /> ~ ~ ~ <br /> 8. - ~ $ <br /> 9. ~ $ <br /> 10. ~ ~ $ <br /> Totals....... $ ~ ~ ~ _ ~o ~ oOs bo <br /> a ~ - <br /> I declare that this statement is, to the best of my knowledge, true, correct and complete. <br /> Grantee's Authorized Signature: Date: a~ <br /> Grantee Contact Phone Number on billing questio . (5Y~ ) ~ ~ g gg <br /> Grantee Contact E-mail Address: e~i C /1. l/~D~~ ~ C~~ eu~~,c~ v~r ccS <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 />