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UC Campus Name Optional address here Intercampus Request for Reimbursement Request # 1 Date: ######## To: Sea Grant Fiscal Team at UCSD Subject: Awarding Agency U-04-SC-005 Allocation $69,500.00 Award/Project Number R/SF-nn Award Balance $64,000.00 Period of Performance 03/01/07-06/30/08 Carry Forward Yes No Our Campus Your Campus Fund Number 12345A 18332A Principal Investigator Henry James Russell Moll Department Marine Sciences California Sea Grant Below is the summary of expenditures & payments for the period from 03/01/07 through 09/30/07: AMOUNT Total Cumulative Expenditures $5,500.00 Less: Payments Received $0.00 Less: Billed but unpaid $0.00 Current Expenditures $5,500.00 Total Amount Due ####### Please prepare the necessary financial journal crediting our Financial Control Account 1195__0 and referencing our Fund Number This financial report is a NOT FINAL If you have any questions, please contact Nancy Smith at (123) 456-7891, email@example.com. Signature of Authorized Official Position Title I certify that the above costs were incurred in the performance of work required under the grant and are consistent with the amounts evidenced by supporting documents and expenditures and are in compliance with the terms and conditions of the award. Additionally, I certify that that all travel expense payments conform to Exhibit B of the Conditions of Award.