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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />Attachment D (Continued) <br />Request for Reimbursement of Funds <br />ITEMIZED LIST FOR REIMBURSEMENT REQUESTS <br />RECIPIENT: INDIAN RIVER COUNTY AGREEMENT #: DMS -P1-24-07-17 <br />Recipient's <br />Reference No. <br />(Warrant, Voucher, <br />Claim check, or <br />Schedule No.) <br />Date of delivery of <br />articles, completion <br />of work, or <br />performance <br />services. <br />DOCUMENTATION <br />List documentation (Recipient's purchase order, signed inventory <br />receipt, and name of the vendor or contractor/subcontractor) by <br />category and line item in the approved project application and <br />give a brief description of the articles orservices. <br />Total Eligible <br />Costs <br />TOTAL <br />DMS -P1-25-07-17 Page 2 of 2 <br />