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I ell <br /> e 1 11 ell <br /> s 'v"°z r y,i a s r xy - n ,x. '� ' x e '�s x Er r M ^c, , w <br /> t x *: ' -a 5 r e" �� rw <br /> - x n : wxed� � xs x , �� - q x * .^ x aax - .'. <br /> 0 y r - s s 1 1 r i a r . s� ( u ae k .� ,� ` r ro... <br /> ��R� a4MM a £ i s <br /> r 'ate''## - 'r <br /> ek' ai m e qV , s xt � s xa{� .g;y d a * h ? <br /> �c . x '�e� ell <br /> �� s r ��"'° r�' _Ile <br /> c Ffa �VW xG <br /> k'I <br /> ell <br /> I ell 6ee F � � 61W 11 <br /> � t is 8@� � s �p9 le I <br /> � 2 9Y5' <br /> 3 � <br /> I ell <br /> �S <br /> Y <br /> rrr .666ler er 11rrIle1 <br /> Grantee Payment date <br /> Address Payment # <br /> Phone # <br /> Agreement # 7Agreement Amount <br /> COSTS INCURRED DURING THE PERIOD OF : / / through <br /> 1 . Salary and Benefits $ <br /> 2 . Other Personal/Contractual Services $ <br /> 3 , Administrative Expenses $ <br /> 4 . Expenses $ <br /> 5 . Operating Capital Outlay ( OCO ) $ <br /> 6 . Fixed Capital Outlay ( FCO ) $ <br /> 7 . Total Expenditures $ <br /> I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement. <br /> Signed <br /> Contract Manager or Financial Officer <br /> I leeVI, <br /> 6% 66 ell <br /> Ile 6 611, 11. 61 all 6 11 ell, <br /> TO BE COMPLETED BY DEM STAFF ONLY <br /> AGREEMENT AMOUNT TOTAL AMOUNT TO BE PAID <br /> PREVIOUS PAYMENT( S ) ON THIS INVOICE <br /> THIS PAYMENT <br /> REMAINING BALANCE <br /> lull <br /> 29 <br />