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CALIFORNIA STATE LIBRARY <br />Library Services and Technology Act <br />FINANCIAL CLAIM <br />1ST PAYMENT <br />FY: 09/10 <br />WP: 08 <br />_. VE N DO R CODE.— M719--,--- <br />SCHEDULE NO: Date: <br />Claim of: Santa Ana Public Library <br />Address: °?6 6�I� � '� 2Z � �✓ z4 �� %/ <br />For: Santa Ana Public Library <br />(Name of System or Agency) <br />Project Title: Connect to Your Future! @ Santa Ana Public Library <br />Amount Claimed: $31,494 Grant Award 1. D. Number: 40 -7321 <br />For Period From: upon execution to end of grant period <br />Type of Payment: PROGRESS FINAL IN FULL <br />Payable Upon Execution of Agreement 07/01/09 <br />CERTIFICATION <br />I hereby certify under penalty of perjury: that I am the duly authorized officer <br />of the claimant herein; that this claim is in all respects true, correct and in <br />accordance with law and the terms of the contract; and that payment has not <br />previously been received for the amount claimed herein. <br />by <br />(Signature of the authorized <br />/ officer of the Fiscal Agency) (Title) <br />State of California <br />State Library Budget Office <br />by <br />date <br />MAIL ONE ORIGINAL SIGNATURE TO: <br />California State Library <br />Budget Office - LSTA <br />P.O. Box 942837 <br />Sacramento, CA 94237 -0001 <br />