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City of Centervflle <br /> 1880 Main Street <br /> e Ile <br /> i-taervi Centerae, MN 55038 <br /> Verifled Maim <br /> Claim of: in Cities Community Capital Fund <br /> Twin Cities Community Capital Fund <br /> 13911 Ridgedale Drive, Suite 260, Minnetonka, MN 55305 <br /> Amount- $ 5,000-00 <br /> Warrant No. <br /> Vendor No. <br /> Dated: 7/12/2005 <br /> Approved: John Al, Meyer Finance Director <br /> I declare under the penalties of pedury that I am the claimant making the within <br /> claim and that the same Is just and truff,that the money therein charged was <br /> actually paid for the purposes therein stated,that the property therein charged <br /> was actually delivered or used for the purposes therein stated,and was of the <br /> value therein charged;that the services therein charged were actually rendered <br /> and were of Me value therein charged,that the fees therein charged are official <br /> and are such as are all by law,and that no part of said claim has own paid. <br /> Signature of Claimant <br /> Date., <br /> (So <br /> Date Activi Distribution- Amount of Acct. No. <br /> 7/12/2005 y for vmrMng cap�,I participation $ 5,000,DO 602-10410 <br /> Totals $ 5,000M <br />