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Your organization’s letterhead <br />TO: Minnesota Department of Transportation <br />Date: <br />State Project number: SP160-246-008 <br />Federal Project number: STP-10 M267(001) <br />Agreement number: 03474 <br />Invoice number: <br />Partial or Final Payment (circle one) <br />Dates this invoice covers: January 2012 to June 2012 (for example) <br />Agreement amount:List total amount of project( local and federal share) . <br />Work completed to date: Briefly list what work has been done . <br />Percentage complete:pp% <br />Amount requested this invoice: $nnnnnn.nn. <br />Amount requested to date: $nnnnnn.nn. <br />Please forward payment to: <br />Project manager must sign <br />Payment requested by: . <br />Approval to pay:TED SCHOENECKER <br />Date:xx/xx/xxxx <br />Enclosures(Include all backup documentation) <br /> <br />