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Anaheim /Santa Ana Urban Areas Security Initiative <br />Reimbursement Request for Grant Expenditures <br />Mail Reimbursement Request to: <br />❑ FY06 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 />O This is the final reimbursement request <br />FY07 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 />LS <br />Under penalty of perjury, I certify that: <br />• 1 am an authorized officer of the claimant herein. <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 an d <br />assurances. <br />All attached invoices for items and/or services have been received in full. <br />Printed Name <br />Mailing Address <br />City, State, zip Code <br />Signature <br />(Please sign in blue ink.) <br />Ana <br />Approved for <br />Authorized Agent <br />Phone Number <br />E -Mail Address <br />Fax <br />Date <br />R No <br />ant Project: <br />ar: <br />s <br />42 <br />Account N: <br />Date: <br />