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• <br />• <br />FORM IRNB'TI <br />DATE: <br />REQUEST FOR DISBURSEMENT <br />Please issue a check from the holding account for <br />(Member Organization) <br />in the IRNIT joint fiber optic cable nctrwork. <br />Balance on hand as of was reported to be <br />Requested amount of check <br />['lease send check to: <br />Make check payable to: <br />Authorized signature; <br />Ufm <br />Joint Fiber Optics Project - Interlocal Agreement <br />Appendix B — Page 5 <br />