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					                 REQUEST FOR ADVANCE                                         OMB APPROVAL NO.                               PAGE                         OF
                  OR REIMBURSEMENT                                                               0348-0004                              1                     1   PAGES
        (Submit this when the project is 100% complete &                     1. TYPE OF PAYMENT          Reimbursement                      2. BASIS OF REQUEST
     reimbursement is requested; complete all shaded fields)                 REQUESTED                       Final                                Cash
3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT                      4. FEDERAL GRANT OR OTHER IDENTIFYING          5. PARTIAL PAYMENT
TO WHICH THIS REPORT IS SUBMITTED                                            NUMBER ASSIGNED BY FEDERAL AGENCY              REQUEST NUMBER
USDA Rural Development                                                                        REAP Grant                                            n/a
6. EMPLOYER IDENTIFICATION NUMBER                                                                8. PERIOD COVERED BY THIS REQUEST
                                                 7. RECIPIENT'S ACCOUNT NUMBER OR IDENTIFYING NUMBER
                                                             n/a               FROM (month, day, year)                           TO (month, day, year)
9. RECIPIENT ORGANIZATION                                                                                                                                10: PAYEE:
                  Name of Business:                                                                                                                           Same
             Project Contact Person:
                             Phone:
                              Email:
                                                                    DESCRIPTION OF WORK COMPLETED
                      Project Name:
           Project Physical Address:


            Summary of installation and
construction steps completed       (Use
                 attachment if lengthy.)



                      Percent completed: 100%
               # employees prior to project
                 # employees after project

  Recommendatons for development of
        similar projects by future USDA
 program applicants                 (Use
                  attachment if lengthy.)


11                                               COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED

              PROGRAMS/FUNCTIONS/ACTIVITIES                                                                                                       TOTAL
a. Total program outlays to date                                                           (i.e., the total project cost)    $                                     100,000
b. Less: Cumulative program income                                                                                          $                                               -
c. Net program outlays (line a minus line b)                                                                                $                                         100,000
d. Estimated net cash outlays for advance period                                                                            $                                               -
e. Total (Sum of Lines c & d)                                                                                               $                                         100,000

f. Non-Federal share of amount on line e                                                                                     $                                         75,000
g. Federal share of amount on line e
                    Enter the total amount of your REAP grant award or 25% of line "a" - whichever is LESS $                                                          25,000
h. Federal payments previously requested                                                                   $                                                                 -
i. Federal share now requested (Line g minus line h)                                                       $                                                          25,000
j. Advances required by month, when requested
                                                 1st month                                                                                          n/a
by Federal grantor agency for use in making      2nd month                                                                                          n/a
prescheduled advances                            3rd month                                                                                          n/a
12                                                                           ALTERNATE COMPUTATION FOR ADVANCES ONLY
a. Estimated Federal cash outlays that will be made during period covered by the advance                                                            n/a
b. Less: Estimated balance of Federal cash on hand as of beginning of advance period                                                                n/a
c. Amount requested (Line a minus line b)                                                                                                           n/a
13                                                                CERTIFICATION
I certify that to the best of my knowledge and belief the data above are correct and that all outlays were made in accordance with the grant conditions or
or other agreements and that payment is due and has not been previously requested.


       SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL


               TYPED OR PRINTED NAME AND TITLE
                      DATE REQUEST SUBMITTED
Documentation supporting this request for funds is attached:
1. Copy of permits (with sign-offs)
2. Technical expert's documentation of system performance
3. Detailed itemization of project expenses with supporting invoices
4. Digital photos (please email these to USDA)



                                                                                                                                                        STANDARD FORM 270 (Rev. 7-97)
AUTHORIZED FOR LOCAL REPRODUCTION                                                                                                             Prescribed by OMB Circulars A-102 and A-110

				
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