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CALIFORNIA STATE LIBRARY INVOICE #: 40-8787-001 <br />Library Services and Technology Act <br />FINANCIAL CLAIM <br />1ST PAYMENT <br />FY: 17/18 <br />FAIN: LS -00-17-0005-17 <br />ITEM NO: 6120-211-0890, Chapter 14, Statutes of 2017 <br />PURCHASING AUTHORITY NUMBER: CSL -6120 <br />REPORTING STRUCTURE: 61202000 <br />GOA: 5432000 <br />PROGRAM #: 5312 <br />SCHEDULE NO: <br />SCHEDULE DATE: DATE: <br />Claim of: Santa Ana Public Library <br />Address: <br />For: Santa Ana Public Library <br />(Name of System or Agency) <br />Project Title: Youth Know: Community Social Innovation Project <br />Amount Claimed: $29,610 Grant Award Number: 40-8787 <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 7/1/2017 <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 />(Signature of the ieuthorized representative) <br />State of California, 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 />FA <br />fz`wl <br />