Laserfiche WebLink
CALIFORNIA STATE LIBRARY <br />Library Services and Technology Act <br />FINANCIAL CLAIM <br />FY: 10/11 <br />WP: 09 <br />VENDOR CODE: M719 <br />SCHEDULE NO: Date: !(?' ! <br />Claim of: Santa Ana Public Library <br />Address: cQ(-P C> (? C jA??Y- SCUA x'44+ ,,,ICA <br />For: Santa Ana Public Library <br />(Name of System or Agency) <br />Project Title: Skills-to-Work: Developing Your Employment Potential <br />Amount Claimed: $5,000 Contract or Grant Award I.D. Number: 40-7747 <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 02/07/11 <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 />b <br />Y <br />(Signature of the uthorize <br />officer of the Fiscal Agency) <br />(Title) 42,0,-??i- lr?n vYl???? <br />State of California <br />State Library Fiscal Office <br />by date <br />MAIL ONE ORIGINAL SIGNATURE TO: <br />California State Library <br />Fiscal Office - LSTA <br />P.O. Box 942837 <br />Sacramento, CA 94237-0001 <br />20B-10