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CALIFORNIA STATE LIBRARY <br />Library Services and Technology Act <br />FINANCIAL CLAIM <br />1ST PAYMENT <br />FY: 12/13 <br />WP: 11 <br />VENDOR CODE: M719 <br />SCHEDULE NO: <br />Claim of: Santa Ana Public Library <br />DATE: 4. 41 11 _5 <br />Address: C ,w ic- ??COV ,, 16, <br />For: Santa Ana Public Library <br />(Name of System or Agency) <br />Project Title: The Santa Ana Civic Archive: Connecting Future Leaders to their Community's Civic Past <br />Amount Claimed: $53,190 Grant Award Number: 40-8195 <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 3/1/2013 <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 />by <br />(Signature of the auth6rized representative) <br />(Title)' <br />----------------------------------------------- ------------------- <br />State of California <br />State Library Fiscal Office <br />by <br />date <br />(State Library representative) <br />MAIL ONE ORIGINAL SIGNATURE TO: <br />California State Library <br />Fiscal Office - LSTA <br />P.O. Box 942837 <br />Sacramento, CA 94237-0001