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Anaheim /Santa Ana Urban Areas Security Initiative <br />Reimbursement Request for Grant Expenditures <br />Mail Reimbursement Request to: <br />FYO6 UASI <br />Anaheim Police Department <br />East Station — Homeland Security Bureau <br />Attn: Lisa Navarro, Grant Coordinator <br />425 S. Harbor Blvd. <br />Anaheim, CA 92805 <br />Agency / City Requesting Reimbursement <br />Total Amount Requested: <br />r Attach conies of supporting in <br />Under penalty of perjury, I certify that: <br />❑ This is the final reimbursement request <br />UASI <br />Santa Ana Police Department <br />Attn: Sgt. Enrique Esparza, Grant Coordinator <br />60 Civic Center Plaza <br />P.O. Box 1981 <br />Santa Ana, CA 92702 <br />• This claim is in all respects true, correct, and all expenditures were made in <br />accordance with applicable laws, rules, regulations and grant conditions and <br />assurances. <br />• All attached invoices for items and/or services have been received in full. <br />Authorized Agent <br />Name <br />Mailing Address <br />State, <br />sign in blue ink.) <br />Approved for <br />Phone Number <br />E.Mail Address <br />Date <br />Request Tracking Number: <br />Grant project: <br />t: Grant: UASI year: <br />Special Instructions l <br />Comments <br />42 <br />Account #: <br />Date: <br />