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.Attachment B <br />(t)rigir«1 Itetlttn•erl~ <br />t't3MR`IC?NWT~1[~TI-! t?1+ VIRGINIA <br />>~ci~s~t~frrterrt of ~tlucttictn <br />E~ftc~: tit' C'at•~:cr~ rrncl Tcclrnicml Ecltrczttion <br />1'«t~. Bo X120 <br />C2ichrntrr~t;1, VA 232 t 8-212Q <br />VIR(;1t~iA. CY~3FRC~iN[P ZDit ~'IaOGRA~M <br />~'T'~.`T~ FUI~i~I~C AI~L~~TItJI~] ~~l'~~IDITUI~C~ I~~P~I~T <br />cht,cr( Divsit~tr Nc~.: <br />Snl~~tc~i Divis[c~n r~~e: <br />.... <br />Rcilt~j~ursetttent ~~. 1 2 ~ ~ <br />1:)t~ctrtt°reniatio~t it~this rejtcrr•t i~ su6r~~ittetl to stli~~oht the Vir~ini<t +~yL~crCai~3j~ 2Ult; I'rc~~rsttlt sl~lc-Ftrt~tt~d <br />e~pcnclitures su1~t~1i(tc~ in ills a}~j~licittican. <br />CER'i'I~tGATIt9N: i +Cgrti#y to the best of my knawledge artd belief that the rttimbursement is true, t;ompre#~, and accurate,. anti the <br />expeatditures attd tltsbursemt:nts are for the purposes and of>jectlves set forth In the terms and conditions ai ~lii~ FetleraNStata <br />rending aliocattou: i am aware that any false, fictitious, orfraudtttent in#armatian; or fife omisstan of any Ittater;~l fact, may subject <br />me to criminal, t:lvif ar admlttistratlve penalties #artraud, Estee statements, false tslaims or otherwise. {tIS. trade Title fH, Sectiaa <br />9001 and Title 31, Sactians 3729-3730 and 3801-3137]. l further certify thak dgcumentatian has been retained in the at#iee of tits <br />eduaatlonai agoncq(arganlzatian and is available upon request [a support the claim. It is uwtderstaad ittat this claim is subject to <br />Cede-al and/or state audits, t3y submitting and approving ibis request, the ®ducatianat agenty(organlzatfan stfbmitter anti <br />approver{s) acknowledge fire cartlilcatian and agree to Its previsions, <br />Vjt•gjtria G~,~bcrCart~lt Z01(i I't~itgt:trn Atxrcrttnt <br />State Allr~catiol~ Ftarcis Paytrtettt~s)1Zeccived: $ <br />__ Total Arttntrnt Cltrimet}. <br />F'I•epitt•el-'s Nttnte: <br />!'re}aarei•,s Telel3hc}llt~ Nit: <br />L7zale <br />L)cz(e <br />(All Signatures must: he in F3t.t1E iRi1t} <br />Pr~~sarer's 1~Mai1: <br />1'ret~ttret°'s f ~tx c~: <br />tfhirrizr C~t~bGr•~zrrtr~ 2(11rt /'r~ngr•trnr -1.7ir•celz~r`.s.'~~rtrr(ur•e <br />~'~ff~r~rimi#~r(dertt ~~ z7r• ~rr(trzai•izert ~~'i~rra(rrre <br />._s_-_ ._.~.,... ___..._~. _.._,----- -------------~.ctr• I~:~~trt~~rrrcr;t r,•~ !?rlrrccttnrr (Lee t3r1~,R_._.. <br />~TAT~ A I..~1~tJCATIt7N F[JNDS <br />Payrttct~t Anlct~it~t(s): $ <br />t'roject Code: <br />5t~tte - G030~ <br />t'aymelrt bat(s): <br />Vottclt~r Nutnl~er(s): <br />!f you have any tluestions, please contact: W. Terry ~lotagherty, CTE Grants Adminisiratar at (804 225-3349 <br />{3#,E ''Kf'S ~;,.:~-v~3r~gk~C~bE3•Vlfi?'~I(llc °~~`.r <br />5ubinit the corrlpleted/signed forts to: Vi#ginia t?epartment of.Education, t;areer and Technical Education, Attn: Grants <br />Adnlinistratar, p.C3. Box 2.121), Richmond, VA 23218-212t) or scanifaxle-mail a I~D~' version in cnln# to; 804-53(}-4560. <br />