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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 />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 />Agency/ City Requesting Reimbursement <br />This is the final reimbursement request. <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 />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 />7 <br />Printed Name Phone Number <br />Title E -Mail Address <br />Mailing Address Fax Number <br />City, State, Zip Code <br />Signature (Please sign in blue ink) Date <br />A101 <br />is <br />g <br />ll ai r, <br />MY 11 <br />Id <br />Ili lh Nfi 6'G r�, n� I�u j "�'yrk�ira i� <br />11;1 5 <br />,it7 Y. I� I;ips k'�bl. <br />Approved for Processing <br />Date <br />Account and Activity Number <br />Grant Year /Grant <br />Project and Solution Area <br />Special Instructions /Comments <br />W <br />