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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br /> REQUEST FOR PAYMENT—PART II <br /> REIMBURSEMENT DETAIL <br /> Grantee Name: I Payment Request No.: <br /> DEP Agreement No.: <br /> Local Share or <br /> Invoice Invoice Amount Other Funding or Requested Amount Task/Deliverable <br /> Vendor Name Number Invoice Date (1) Amount Not (3) Check Number Number(4) <br /> Requested(2) <br /> $ - 4 $ - <br /> $ - $ - <br /> $ - $ - <br /> $ - $ - <br /> $ - $ - <br /> $ $ <br /> $ - $ - <br /> $ - $ <br /> $ - $ - <br /> $ - $ <br /> $ - $ - <br /> $ - $ - <br /> Totals: $ - $ - <br /> DEP Agreement No.NS027,Exhibit D,Page 4 of 5 <br />