Form SFN8387 "Request for Reimbursement - Abandoned Motor Vehicle Program" - North Dakota

What Is Form SFN8387?

This is a legal form that was released by the North Dakota Department of Health - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2006;
  • The latest edition provided by the North Dakota Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN8387 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN8387 "Request for Reimbursement - Abandoned Motor Vehicle Program" - North Dakota

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REQUEST FOR REIMBURSEMENT - ABANDONED MOTOR VEHICLE PROGRAM
NORTH DAKOTA DEPARTMENT OF HEALTH
Telephone: 701-328-5166
DIVISION OF WASTE MANAGEMENT
þÿClear Fields
Fax Number: 701-328-5200
SFN 8387 (5/2006)
Website: www.ndhealth.gov/wm
SECTION 1. ADMINISTRATIVE SECTION
Name of Government Unit:
Telephone Number:
Check One:
Applicant Name:
Address:
Fax Number:
Position:
City:
State:
Zip Code:
Department Contact and Phone Number:
Amount Requested:
Date of Request:
Project Name:
Contract Dates:
Contract Number:
SECTION 2. BUDGET EXPENDITURES
Hours 
Hourly
Personnel (Name)
Title or Position
Claimed 
Amount Requested
Wage
1.
($
.00)
2.
($
.00)
3.
($
.00)
SECTION 3. SURVEY PHASE
Number of townships surveyed at ($
.00)
( Please attach list.)
Number of townships with one release form ($
.00)
(Please identify on list.)
Number of satisfactorily completed release forms ($
.00)
(Please send originals to the Department.)
Miscellaneous supplies and office materials necessary to complete survey:
(Please attach itemization.)
(Please attach receipts.)
Costs for advertisement of bids:
Mileage (Please certify with signature:
)
Incentive payment of ($
per ton):
SECTION 4. COLLECTION PHASE
Cost of collection, crushing, and transportation:
(Please attach weight tickets and receipts.)
(Please attach itemization.)
Miscellaneous supplies and office materials necessary to complete collection:
TOTAL AMOUNT REQUESTED FOR REIMBURSEMENT
SECTION 5. SIGNATURES
Reviewed by NDDH Representative and Date:
Unit of Government:
Title:
Title:
Recommended Payment Aount:
Signature of Grantee and Date:
The applicant certifies that the foregoing information is true, correct, and complete, and that payment (reimbursement) has not been received.
SEND REQUEST FOR REIMBURSEMENT TO:
ND Department of Heath
Division of Waste Management
918 E. Divide Ave.
Bismarck, ND 58501-1947
REQUEST FOR REIMBURSEMENT - ABANDONED MOTOR VEHICLE PROGRAM
NORTH DAKOTA DEPARTMENT OF HEALTH
Telephone: 701-328-5166
DIVISION OF WASTE MANAGEMENT
þÿClear Fields
Fax Number: 701-328-5200
SFN 8387 (5/2006)
Website: www.ndhealth.gov/wm
SECTION 1. ADMINISTRATIVE SECTION
Name of Government Unit:
Telephone Number:
Check One:
Applicant Name:
Address:
Fax Number:
Position:
City:
State:
Zip Code:
Department Contact and Phone Number:
Amount Requested:
Date of Request:
Project Name:
Contract Dates:
Contract Number:
SECTION 2. BUDGET EXPENDITURES
Hours 
Hourly
Personnel (Name)
Title or Position
Claimed 
Amount Requested
Wage
1.
($
.00)
2.
($
.00)
3.
($
.00)
SECTION 3. SURVEY PHASE
Number of townships surveyed at ($
.00)
( Please attach list.)
Number of townships with one release form ($
.00)
(Please identify on list.)
Number of satisfactorily completed release forms ($
.00)
(Please send originals to the Department.)
Miscellaneous supplies and office materials necessary to complete survey:
(Please attach itemization.)
(Please attach receipts.)
Costs for advertisement of bids:
Mileage (Please certify with signature:
)
Incentive payment of ($
per ton):
SECTION 4. COLLECTION PHASE
Cost of collection, crushing, and transportation:
(Please attach weight tickets and receipts.)
(Please attach itemization.)
Miscellaneous supplies and office materials necessary to complete collection:
TOTAL AMOUNT REQUESTED FOR REIMBURSEMENT
SECTION 5. SIGNATURES
Reviewed by NDDH Representative and Date:
Unit of Government:
Title:
Title:
Recommended Payment Aount:
Signature of Grantee and Date:
The applicant certifies that the foregoing information is true, correct, and complete, and that payment (reimbursement) has not been received.
SEND REQUEST FOR REIMBURSEMENT TO:
ND Department of Heath
Division of Waste Management
918 E. Divide Ave.
Bismarck, ND 58501-1947