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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />At.tachrnentD. <br />DMSION OF-EMERGENCY—]MANAGEMENT <br />REQUESTFOR ADVANCE" �,OR',,REIIIWI-BURSEIVIENT OF <br />HAZARD01,11'dA T -I O'N''A'S'S"Ilbt*CE` Pk GRAM FUNDS <br />SUB-6RECIPIENT: INDIAN -RIVER COUNTY <br />REMIT ADDRESS: <br />CITY: STATE: ZIP CODE: <br />PROJECT TYPE: Elevation PROJECT M 4283-91-R <br />PROGRAM: Hazard ,,Mkig aticn;,Gran tProg ra . n <br />CONTRACTM .-HOON <br />APPROVED BUDGET: FEDERAL SHARE: MATCH: <br />. . .. ...... <br />AbVANCE*DR;'ECEIVED: WA <br />AMOUNT: SETTLED? <br />Invoice Period: TO Payment M <br />7 <br />Eli able Amount j Obligated Federal Obligated:Nofi- <br />Arno <br />Division Use Only <br />000/w 'Amount Fetleral <br />-00% <br />*qwst) <br />Current 76. 261.606% Approved I _ -T —Comments <br />TOTAL CURRENT -REQUEST: <br />By signing.this •report, I-certify4o the best ofmy,knovAedge,and;'6kef that the report is true, complete, and accurate, <br />andAh6-6*pendft6i0s dliburiaments and cash =rdceiotsfsre for,1h',purposes and o4joctives set forth 1n,the terms and <br />conditibris:-6f.iha fed ra <br />the I am aware -1hat ,.any ,'fbIw i,.fidt idus, orftudulent lnfbrmafi . on, or the omission of. any <br />0 <br />matenal fad, may subject me to criminal, civil administrative for fraud, false <br />statements, false claims or <br />othoftei Sedioh-1 001,afid:TM'e-'Ol,-,'Sedt.i'o'iiO 3729,3730 and 39014812. <br />SUS-RECIPIENTSIGNATURE: <br />NAME / TiTLE: DATE: <br />PROJECT TOTAL $ <br />COST $ <br />FOR PAYMENT $ <br />TO BE COMPLETED BY THE DIVISION <br />46 <br />