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<br />CALIFORNIA STATE LIBRARY <br />Library Services and Technology Act <br />FINANCIAL CLAIM <br />FY: 11/12 <br />WP: 10 <br />VENDOR CODE: M719 <br />SCHEDULE NO: DATE <br />Claim of: Santa Ana Public Library <br />°i?u?I <br />Address: G ?-Lky OC;cza, QI?L'?Ch AA/yCR <br />For: Santa Ana Public Library <br />(Name of System or Agency) <br />Project Title: Literacy on the Move: Enhancing Literacy Skills Throughout the Community <br />Amount Claimed: $4,983 Grant Award Number: 40-8024 <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 1/13/2012 <br />------------------------------------------------------------------------------------------------------------------------------------------- <br />CERTIFICATION <br />I hereby certify under penalty of perjury: that I am the duly authorized <br />representative of the claimant herein; that this claim is in all respects true, <br />correct and in accordance with law and the terms of the agreement; and that <br />payment has not previously been received for the amount claimed herein. <br />---------------------------------------------- <br />State of California <br />State Library Fiscal Office <br />by <br />by A%?? <br />(Signature of the au orized representative) <br />Title <br />;, ??yYlll?1? ?`'h fir' l(' <br />) <br />.----------------------------------------------------------------- <br />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 />(State Library representative)