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Mn«OT 30172: KMlMd 11/00; Wwd Version <br />STATE AID PAYMENT REQUEST <br />Coun <br />LetDat* <br />OtLdiAO Report: InWai <br />L /Award Date: <br />.Partial <br />______/ <br />V1(iVl.S<»fety I'hvj. “ <br />Final Piolact*IS2 .Q\0 .^1 <br />/ / ms <br />Bond Company <br />_ Constr. Completed <br />Local Project ID # (optional):___ <br />Prelaet Pundino: Funtfng below it for this project number only. Costs for projecit or agreements tied to this project should <br />not be Includedron this request A separate State Aid Payment Request must be submitted for each project number. Final <br />reports must Include a final estimale detailing quantity, unit price and extension spits for each project number. <br />mraetCoata Ithia SAP onM <br />FUND <br />Munidpai (MSAS^iver 5000 pop.) <br />Regular (CSAH) <br />Municipal (CSAH-under 5000 pop.) <br />Town Bridge <br />Turnback (County or Munic.) <br />State Park Road <br />Disaster <br />State Aid Bortds <br />Bridge Bonding <br />Federal <br />Local <br />Total Costs to Date Previous Payments Pav at this Tima <br />$. <br />$. <br />$. <br />$. <br />$. <br />Local - Credit for Local Effort <br />Sub-Total <br />Other Coats <br />FUND *0E8CRIPTK>NFUND •DESCRIPTION \ <br />P D £ A S 111 0 |3><SiO 8 Hj sC S9C5H) <br />TOTAL <br />Remarks: <br />» I ‘IB, 691 M »ll <r,g46.'?7 .32^03?. 22 <br />1\6d ir) P. 2DI3 ^64 SU-Mvy ____ <br />•Descrlptien: Righhel^vroy (ROW). Prajaet Oewe lopmsnt (PO)-2S% Max. Foiea Acoount (FA), ale. Fores Aeoeuni MudM woA not <br />psifonnsd by eoflifselor such as xmifc ^ dty, county, or MnOOT forees, MR or uMy worti, or agency fijmislied materials. <br />the mMmum twuriy raiss laqubad tor work on stale fimdod eeiwlntetien projects as dolsmilnsd by the MN Oapt or Labor and Indusby. maiarialt <br />^ WyCP/^ <br />Dale Approved by: District Sfole AM En^teer <br />______________/ / <br />Date <br />iU^MroRdtomaaSitomnMs