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EXHIBIT D <br />FLORIDA INLAND NAVIGATION DISTRICT <br />ASSISTANCE PROGRAM <br />PAYMENT REIMBURSEMENT REQUEST FORM <br />NUE COPY <br />CERTIFICATION ON LAS I PAGE <br />J.R. SMITH, CLERK <br />PROJECT NAME: PROJECT #: <br />PROJECT SPONSOR: BILLING #: <br />Amount of Assistance <br />All Funds Previously Requested <br />Balance Available <br />Funds Requested <br />Less Retainage (-10% unless final) <br />Check Amount <br />Balance Available <br />Less Check Amount <br />Balance Remaining <br />SCHEDULE OF EXPENDITURES <br />Expense Description Check No. Total Applicant FIND <br />(Should correspond to Vendor Name and Date Cost Cost Cost <br />Cost Estimate Sheet <br />Categories in Exhibit "A") <br />FIND - Form No 90-14 (NOTE. Signature Required on Page 2) <br />Effective Date 7-30-02) <br />