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<br />Request for Reimbursement Submittal Confirmation <br />Please complete and return to NC DOT/PTD with your first invoice <br />Grantee: ~l2A-r,c-~ ~~c.r11-, <br />Requests for Reimbursement will be submitted: <br />Monthly Monthly Reports Due: August 30, 2010 <br />October 31, 2010 <br />December 31, 2010 <br />February 28, 2011 <br />Apri130, 2011 <br />June 30, 2011 <br />X Quarterly Quarterly Reports Due: <br />Authorized Signature <br />a~ <br />Date: I ~ 1 ~ <br />Project #: /~ " C/ ~.~~ <br />WBS Element: 3(.1233, $a.'~, ~ <br />Period of Performance~jQ=(.~3G~// <br />September 30, 2010 <br />November 30, 20108 <br />January 31, 2011 <br />March 31, 2011 <br />May 31, 2011 <br />September 30, 2010 , <br />December 31, 2010 <br />March 30, 2011 <br />June 30, 2011 <br /> <br />Revised 10/28/2010 <br />Page 1 of 1 <br />NCDOT/PTD/FM <br />