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Certificate of Campletioa <br />1. Name of Reci lent: 3. Pro'ect Nnmber. Hl]- <br />2. Grant Namber: a. Pro ect Name: <br />S. Final Statement of Cosh <br /> To Be Completed To Be Completed <br /> Reci tent B DCA <br /> Paid Unpaid Total Costs Approved <br />Pmgram Activity Categories Costs Costs (CoL b + c) Total Costs <br />a c <br />e <br />a. Ac uisition <br />b. sition <br />c. Public facilities and im vements <br />1 Senior and bandit centers <br />2 Parks la ands and recreation facilities <br />3 Nei borhood facilities <br />4 Solid waste di facilities <br />S Fire tection facilities and i eat <br />Parkin facilities <br />Public utiliti other than water and sewer <br />8 Water and sewer im vements <br />Street im rovements ~ _ <br />10 Flood and aim ants <br />11 Pedestrian im vements <br />12 Other ublic facilities <br />13 Sewer im rovements , <br />14 water im vements 15 061 1 ,061 <br />d. Clearance activities <br />e. Public services <br />f. Relocation assistance <br />. Constructio rehab. and reservation activities <br />1 Construction or rehab. of tom. dt Indust. bl <br />2 Rehabilitation of 'vote owned buildin <br />3 Rehabilitation of blic owned boil ' <br />4 Cade enforcement <br />5 Historic reservation <br />h. De~elo ant financin <br />1 Workin c ital <br />2 Machin and ant <br />i. Removal of architectural barriers <br />Other activities <br />1` Subtotal 124,061 <br />1. Plannin <br />m. Administration <br />n. Total <br />o. Less: Pro Income A lied to Costs 50 <br />. E nal: Grant Amount A lied to Costs ~ <br />6. Co m atation of Great ]Balsace <br /> To Be To Be <br /> Ca~ntpleted 13y Completed Sy <br /> tent DCA <br />(a) Approved <br /> Amonnt Amount <br /> c <br />1 Grant Amount A lied Ta Casts rom Line <br />2 Estimated Amount For Unsettled Third - Claims <br />3 Subtotal 137, 011 <br />4 Grant Amount Per Grant A eat 145 750 <br />Unutilized Grant To Be Canceled ine 4 Minus Line 3 <br />Grant Funds Received <br />Balance of Grant le ine 3 Minus Line ' <br />* If Line 6 exceeds Line 3, enter the amount of the excess on Line 7 as a negative amount. This amount shall be <br />repaid to DCA by check, unless DCA has previously approved use of these funds. <br />