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ATTACHMENT B <br />Disbursement Request Package <br />Legislative Projects (LP) Grants <br />1. Grantee/Recipient INDIAN RIVER COUNTY <br />2 Project Number LP31010 Date of Request <br />3. Disbursement Request Number <br />4. Type of Request Partial [ <br />5. Federal Employer Identification Number <br />6. Mail ❑ EFT ❑ Send Remittance to: <br />Required Match % <br />Final <br />El <br />Disbursement Details <br />(cumulative amounts rounded to the nearest dollar) <br />1. Professional Services (attach invoices) <br />2 Construction and Demolition (attach invoices) <br />3. Equipment (attach invoices) <br />4. Land (attach invoices) <br />5. Other (list - must be specified in Project Work Plan) <br />6. Total cumulative to date <br />7. Disbursements previously requested <br />8. Amount requested for disbursement (line 6 minus line 7) <br />$( <br />** SUBMIT ONE ORIGINAL COPY OF THIS FORM AND SUPPORTING DOCUMENTATION TO: ** <br />Florida Department of Environmental Protection <br />Bureau of Water Facilities Funding MS 3505 <br />2600 Blair Stone Road <br />Tallahassee Florida 32399-2400 <br />DEP Agreement No. LP31010, Attachment B, Page 1 of 3 <br />