2022-08-15 DEED Reimbursement Payment RequestFORM # MN-DEED-AFS-02 1 3.1.13
REIMBURSEMENT PAYMENT REQUEST �� EMPLOYMENT AND
Submit com leted form via email to our DEED Program Contact 'ECONOMIC DEVELOPMENT
SWIFT PO ID PO LINE AMOUNT FUND
FIN DEPT ID
APPROP ID
ACCOUNT AGENCY COST
PROJECT ID
3�31330 1 $450,000 1000
B223130S
B221150
55351
B2 MMIFGF
2
TOTAL 450,000 NOTES:
ACTIVITY ID COST CATEGORY DESCRIPTION (PER
A. APPROVED
B. PREVIOUS
C. REIMB.
E. (A - D = E)
APPROVED BUDGET)
BUDGET
REIMB.
REQUESTED D. (B + C = D)
AVAILABLE F. UNSPENT
REQUEST
THIS PERIOD TOTAL REIMB.
BALANCE OBLIGATIONS
884 Machinery $ Equipment
450,000
0
450,000 450,000
0 N/A
0
0
0 0
0 N/A
0
0
0 0
0 NIA
0
0
0 0
0 N/A
0
0
0 0
0E N/A
TOTAL
450,000
0
450,000 450,000
0 0
THIS IS THE SPACE TO PLACE ANY REMARKS OR ADDITIONAL COMMENTS AS NECESSARY.
I
By submitting this form, I certify that the request is in accordance with DEED cash management requirements and appropriate contract terms; th
excess of immediate disbursement needs. e data reported is correct eand the amount of the request is not i� If submitting this forth via email, without signature affixed below, place the statement above In the body of your email. By doing so, the sender of the email designates they are hereby authorized to
provide approval of this request. Without a signature and/or statement included in the body of the email the form will be rejected.
8/15/2022
Grantee Authorized Signature V Date DEED Staff Authorized Signature Date
Adam Nafstad, City Administrator
Grantee Typed Name and Title Office of Business Finance Director Date