Laserfiche WebLink
EXHIBIT D <br />FLORIDA INLAND NAVIGATION DISTRICT <br />ASSISTANCE PROGRAM <br />PAYMENT REIMBURSEMENT REQUEST FORM <br />PROJECT NAME: <br />PROJECT SPONSOR: <br />PROJECT #: <br />BILLING #: <br />Amount of Assistance <br />Less Previous Total Disbursements A. <br />Less Previous Total Retainage Held B. <br />Balance Available = <br />Funds Requested This Disbursement <br />Funds Requested C . <br />Less Retainage (-10% unless final) D. <br />Check Amount = <br />Amount of Assistance <br />Less Total Prior and Current Payments <br />Including all retainage held (A+B+C+D) <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 - Forrn No. 90-14 (NOTE: Signature Required on Page 2) <br />Effective Date 7-30-02) 61 <br />