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67' <br />Encumbrance Worksheet <br />(Attach to all contracts. arants. and amendments) <br />Vendor Name: <br />Vendor Number: <br />City of St. Anthony Village <br />$ 10,000 <br />Address: <br />Federal Employer I.D. or Social Security #: <br />3301 Silver Lake Rd. NE <br />� <br />City, State, Zip: <br />Minnesota Tax I.D. No. (if applicable): <br />St. Anthony, MN 55418-1667 <br />$ 101000 <br />Starting Fiscal Year: <br />2012 <br />Total Amount of Agreement: <br />$ 10,000 <br />Start Date: I <br />6/1512012 <br />End Date: 6/30/2013 <br />H123 2100 <br />Accounting Information <br />Fiscal Year 1 <br />Fund <br />Dept ID <br />Appr ID <br />Project ID <br />Activity ID <br />Amount <br />2302 <br />H123 2100 <br />H12552P <br />H12 -111-1011A <br />2137 <br />$ 101000 <br />H123 <br />$ <br />H123 <br />$ <br />H123 <br />$ <br />H123 <br />$ <br />CFDA # (if Federal $) <br />Fiscal Year 2 <br />---- --...--- <br />Fund <br />Dept ID <br />Appr ID <br />Project ID <br />Activity ID <br />Amount <br />H123 <br />$ <br />H123 <br />$ <br />H123 <br />$ <br />CFDA # (if Federal $) <br />Fiscal Year 3 <br />---- --...--- <br />Fund <br />Dept ID <br />Appr ID <br />Project ID <br />Activity ID <br />Amount <br />H123 <br />$ <br />H123 <br />$ ---- <br />H123 <br />$ <br />CFDA # (if Federal $) <br />mr_uinrW <br />NOTE: This page of the Agreement Contract contains confidential information and should not be reproduced or distributed externally without written <br />permission from the Vendor. Internal circulation of this page should only be to individuals/offices signing this Agreement Contract and those that require <br />access to the tax identification number. <br />Financial Management (651) 201-4622 7/26/11 <br />