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EXHIBIT D <br />Anaheim and Santa Ana Urban Areas Security Initiative <br />Reimbursement Request for Grant Expenditures <br />Mail Reimbursement Request To: <br />1-1 This is the final reimbursement request. <br />Sgt. Enrique Esparza, Grant Coordinator <br />Santa Ana Police Department <br />Homeland Security Division <br />60 Civic Center Plaza-P.O. Box 1981 <br />Santa Ana. CA 92702 <br />Cindy Nickel, Grant Fiscal Coordinator <br />Anaheim Police Department <br />East Station-Homeland Security Bureau <br />425 S. Harbor Boulevard <br />Anaheim, CA 92805 <br />I Agency/ City Requesting Reimbursement <br />Payroll Total (Salaries, Overtime, Backfill, etc) <br />Travel Total (Tuition, Meals, Lodging, etc) <br />Equipment & Supplies Total <br />Total Amount Requested a - <br />Under Penalty of perjury, I certify that: <br />I am the duly authorized officer of the claimant herein. This claim is in all respects true, correct, and all <br />expenditures were made in accordance with applicable laws, rules, regulations, and grant conditions and <br />assurances. All attached documents for items and/or services have been received in full. <br />tall <br />,',4r. rlalw' "J+."'!'?w d.i?'seYx ?r 4 ':.i3B4k: ri y •ra .^ii:?. ,,y?zr ;?'.:??,., ',;;i :;.}d: r od- r r?7? <br />t' '?!. z' s f`•. ?? <br />i 5 tv ;r i ?, rr R4 4t? y l??,'. 4l r s `'S?;itL"'r? ..1 r r5 P' t ry!Y; <br />a s'd? .1! t'??rt 91•. ^,? i vlt,; '?i?ei.(t?,!.:.??. hrs. Ott "t't lutY ?tul i'?"PeR E' '?I'1 '? Nl" i. tr. ,r :r:4 r <br />Printed Name <br />Title <br />Mailing Address <br />City, State, Zip Code <br />Signature (Please sign in blue ink) <br />Phone Number <br />E-Mail Address <br />Fax Number <br />Date <br />!i 1A [ ? 1 p <br />Approved for Processing Date <br /> <br />Account and Activity Number <br /> <br />Grant Year/Grant Project and Solution Area <br /> <br />Special Instructions/Comments <br />38