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Err. <br />0 <br />•• EXHIBIT C <br />FLORIDA INLAND NAVIGATION DISTRICT <br />WATERWAYS ASSISTANCE PROGRAM <br />REIMBURSEMENT REQUEST FORM <br />PROJECT NAMES GRANTEES <br />PROJECT NO. s BTI.I.TNO NO. t <br />RILING PERIODS <br />MINDS REQUESTEn* <br />Amount of Grant <br />Funds Previously Requested <br />Salam* Available <br />Funds Requested <br />Less Retainage (DAX) <br />Check Amount <br />Balance Remaining <br />(Balance; Available minus <br />check amount) <br />• <br />SCHEDULE OF EXPENDITURES <br />• <br />Check No. General Description Total Applicant FIND <br />Vendor Name and Date & Project Element Cost Cost Cost <br />(Should correspond to <br />Cost Estimate Sheet) <br />Certification for Reimbursements I certify that the shove expenses were c <br />incurred for the approved project -and that the progress of the project 1.o conetetent '�. <br />with the amount requested. <br />q Project Administrator hate <br />g. Financial Officer Date <br />FIND - Form No. 90-24 <br />Rev. 9/?5J90 <br />