**U.S. DEPARTMENT OF ENERGY JUNE 2005**

**FINANCIAL ASSISTANCE**

**PROPERTY CLOSEOUT CERTIFICATION**

+-----------+----------------------------------------------------------+
| **Award   | **Recipient** *(Name and address)*                       |
| Number**  |                                                          |
|           |                                                          |
|           |                                                          |
+-----------+----------------------------------------------------------+
| The       |                                                          |
| purpose   |                                                          |
| of this   |                                                          |
| report is |                                                          |
| to        |                                                          |
| f         |                                                          |
| acilitate |                                                          |
| the       |                                                          |
| closeout  |                                                          |
| of the    |                                                          |
| Award.    |                                                          |
| Based on  |                                                          |
| the       |                                                          |
| records   |                                                          |
| m         |                                                          |
| aintained |                                                          |
| by the    |                                                          |
| Recipient |                                                          |
| in        |                                                          |
| a         |                                                          |
| ccordance |                                                          |
| with the  |                                                          |
| Property  |                                                          |
| M         |                                                          |
| anagement |                                                          |
| standards |                                                          |
| set forth |                                                          |
| in the    |                                                          |
| Award,    |                                                          |
| the       |                                                          |
| following |                                                          |
| data      |                                                          |
| reflects  |                                                          |
| the       |                                                          |
| Re        |                                                          |
| cipient's |                                                          |
| closeout  |                                                          |
| inventory |                                                          |
| of real   |                                                          |
| and       |                                                          |
| personal  |                                                          |
| property  |                                                          |
| that was  |                                                          |
| provided  |                                                          |
| by the    |                                                          |
| D         |                                                          |
| epartment |                                                          |
| of Energy |                                                          |
| (DOE) or  |                                                          |
| partially |                                                          |
| or wholly |                                                          |
| acquired  |                                                          |
| with      |                                                          |
| project   |                                                          |
| funds.    |                                                          |
+-----------+----------------------------------------------------------+
| **I.      |                                                          |
| EQ        |                                                          |
| UIPMENT** |                                                          |
+-----------+----------------------------------------------------------+
| A.        |                                                          |
|   **[Fede |                                                          |
| rally-Own |                                                          |
| ed]{.unde |                                                          |
| rline}:** |                                                          |
|     *(G   |                                                          |
| overnment |                                                          |
|           |                                                          |
| Furnished |                                                          |
|     Equ   |                                                          |
| ipment):* |                                                          |
|     *(10  |                                                          |
|     CFR   |                                                          |
|     60    |                                                          |
| 0.133(a), |                                                          |
|           |                                                          |
|  600.232, |                                                          |
|           |                                                          |
|  600.322, |                                                          |
|     or    |                                                          |
|           |                                                          |
|   Federal |                                                          |
|     Demo  |                                                          |
| nstration |                                                          |
|     Pa    |                                                          |
| rtnership |                                                          |
|     (     |                                                          |
|     FDP)  |                                                          |
|           |                                                          |
|   General |                                                          |
|     Terms |                                                          |
|     and   |                                                          |
|     C     |                                                          |
| onditions |                                                          |
|     No.   |                                                          |
|     33,   |                                                          |
|     as    |                                                          |
|     appl  |                                                          |
| icable):* |                                                          |
|     No    |                                                          |
|     Yes   |                                                          |
|           |                                                          |
| > (*If    |                                                          |
| >         |                                                          |
|  **yes,** |                                                          |
| > attach  |                                                          |
| >         |                                                          |
|  property |                                                          |
| >         |                                                          |
| inventory |                                                          |
| > list    |                                                          |
| > that    |                                                          |
| >         |                                                          |
|  includes |                                                          |
| > item    |                                                          |
| > des     |                                                          |
| cription, |                                                          |
| > manu    |                                                          |
| facturer, |                                                          |
| > model,  |                                                          |
| > serial  |                                                          |
| > number, |                                                          |
| >         |                                                          |
|  original |                                                          |
| > ac      |                                                          |
| quisition |                                                          |
| > date,   |                                                          |
| >         |                                                          |
|  original |                                                          |
| > ac      |                                                          |
| quisition |                                                          |
| > cost    |                                                          |
| > and     |                                                          |
| >         |                                                          |
|  disposal |                                                          |
| >         |                                                          |
| condition |                                                          |
| > code    |                                                          |
| > per the |                                                          |
| > Federal |                                                          |
| > M       |                                                          |
| anagement |                                                          |
| > R       |                                                          |
| egulation |                                                          |
| > 102     |                                                          |
| -36.240)* |                                                          |
+-----------+----------------------------------------------------------+
| > **B.**  |                                                          |
| > **[     |                                                          |
| Equipment |                                                          |
| >         |                                                          |
|  Acquired |                                                          |
| > with    |                                                          |
| > Award   |                                                          |
| > Funds   |                                                          |
| > where   |                                                          |
| > Title   |                                                          |
| > Vests   |                                                          |
| > in the  |                                                          |
| >         |                                                          |
| Recipient |                                                          |
| > with    |                                                          |
| > further |                                                          |
| > ob      |                                                          |
| ligations |                                                          |
| > to      |                                                          |
| > D       |                                                          |
| OE:]{.und |                                                          |
| erline}** |                                                          |
| > *(10    |                                                          |
| > CFR     |                                                          |
| >         |                                                          |
|  600.133, |                                                          |
| >         |                                                          |
|  600.134, |                                                          |
| >         |                                                          |
|  600.232, |                                                          |
| > or      |                                                          |
| >         |                                                          |
|  600.321, |                                                          |
| > as      |                                                          |
| > app     |                                                          |
| licable)* |                                                          |
| >         |                                                          |
| > No Yes  |                                                          |
| >         |                                                          |
| > If      |                                                          |
| >         |                                                          |
|  **yes,** |                                                          |
| > does    |                                                          |
| > the     |                                                          |
| >         |                                                          |
| equipment |                                                          |
| > have a  |                                                          |
| > per     |                                                          |
| > unit    |                                                          |
| > fair    |                                                          |
| > market  |                                                          |
| > value   |                                                          |
| > of      |                                                          |
| > \$5,000 |                                                          |
| > or      |                                                          |
| > more?   |                                                          |
| > No Yes  |                                                          |
| >         |                                                          |
| > *(If    |                                                          |
| >         |                                                          |
|  **yes**, |                                                          |
| > attach  |                                                          |
| > a       |                                                          |
| >         |                                                          |
|  property |                                                          |
| >         |                                                          |
| inventory |                                                          |
| > list    |                                                          |
| > that    |                                                          |
| >         |                                                          |
|  includes |                                                          |
| > item    |                                                          |
| > des     |                                                          |
| cription, |                                                          |
| > manu    |                                                          |
| facturer, |                                                          |
| > model,  |                                                          |
| > serial  |                                                          |
| > number, |                                                          |
| >         |                                                          |
|  original |                                                          |
| > ac      |                                                          |
| quisition |                                                          |
| > date,   |                                                          |
| >         |                                                          |
|  original |                                                          |
| > ac      |                                                          |
| quisition |                                                          |
| > cost,   |                                                          |
| >         |                                                          |
|  disposal |                                                          |
| >         |                                                          |
| condition |                                                          |
| > code    |                                                          |
| > per the |                                                          |
| > Federal |                                                          |
| > M       |                                                          |
| anagement |                                                          |
| > R       |                                                          |
| egulation |                                                          |
| > 1       |                                                          |
| 02-36-240 |                                                          |
| > and one |                                                          |
| > of the  |                                                          |
| > di      |                                                          |
| sposition |                                                          |
| > codes   |                                                          |
| > listed  |                                                          |
| > below)* |                                                          |
| >         |                                                          |
| > \(1\)   |                                                          |
| > The     |                                                          |
| >         |                                                          |
|  property |                                                          |
| > will    |                                                          |
| >         |                                                          |
|  continue |                                                          |
| > to be   |                                                          |
| > used    |                                                          |
| > for the |                                                          |
| >         |                                                          |
|  purposes |                                                          |
| > a       |                                                          |
| uthorized |                                                          |
| > in the  |                                                          |
| > Award.  |                                                          |
| >         |                                                          |
| > \(2\)   |                                                          |
| > The     |                                                          |
| >         |                                                          |
|  property |                                                          |
| > is no   |                                                          |
| > longer  |                                                          |
| > needed  |                                                          |
| > for the |                                                          |
| >         |                                                          |
|  purposes |                                                          |
| > of the  |                                                          |
| > Award,  |                                                          |
| > and     |                                                          |
| > will be |                                                          |
| > used on |                                                          |
| > another |                                                          |
| >         |                                                          |
| Federally |                                                          |
| >         |                                                          |
| sponsored |                                                          |
|           |                                                          |
| activity  |                                                          |
| *(List    |                                                          |
| Activity  |                                                          |
| and       |                                                          |
| Federal   |                                                          |
| Agency):* |                                                          |
|           |                                                          |
| (3) The   |                                                          |
|           |                                                          |
| Recipient |                                                          |
|           |                                                          |
|    wishes |                                                          |
|     to    |                                                          |
|           |                                                          |
|    retain |                                                          |
|     the   |                                                          |
|           |                                                          |
|  property |                                                          |
|     and   |                                                          |
|     c     |                                                          |
| ompensate |                                                          |
|     DOE   |                                                          |
|     for   |                                                          |
|     its   |                                                          |
|     share |                                                          |
|     of    |                                                          |
|     the   |                                                          |
|           |                                                          |
|   current |                                                          |
|     per   |                                                          |
|     unit  |                                                          |
|     fair  |                                                          |
|           |                                                          |
|    market |                                                          |
|           |                                                          |
|    value. |                                                          |
|     *     |                                                          |
| (Identify |                                                          |
|     the   |                                                          |
|     fair  |                                                          |
|           |                                                          |
|    market |                                                          |
|     value |                                                          |
|     on    |                                                          |
|     the   |                                                          |
|           |                                                          |
|  attached |                                                          |
|           |                                                          |
|  property |                                                          |
|           |                                                          |
| inventory |                                                          |
|     list  |                                                          |
|     and   |                                                          |
|           |                                                          |
|  describe |                                                          |
|     how   |                                                          |
|     the   |                                                          |
|     value |                                                          |
|     was   |                                                          |
|     dete  |                                                          |
| rmined).* |                                                          |
|           |                                                          |
| (4) The   |                                                          |
|           |                                                          |
|  property |                                                          |
|     is no |                                                          |
|           |                                                          |
|    longer |                                                          |
|           |                                                          |
|    needed |                                                          |
|     for   |                                                          |
|     the   |                                                          |
|           |                                                          |
|  purposes |                                                          |
|     of    |                                                          |
|     the   |                                                          |
|     Award |                                                          |
|     or    |                                                          |
|     other |                                                          |
|           |                                                          |
| Federally |                                                          |
|           |                                                          |
| sponsored |                                                          |
|     a     |                                                          |
| ctivities |                                                          |
|     and   |                                                          |
|     the   |                                                          |
|           |                                                          |
| Recipient |                                                          |
|           |                                                          |
|  requests |                                                          |
|     DOE   |                                                          |
|     di    |                                                          |
| sposition |                                                          |
|     inst  |                                                          |
| ructions. |                                                          |
+-----------+----------------------------------------------------------+
|           |                                                          |
+-----------+----------------------------------------------------------+
| **II.     |                                                          |
| S         |                                                          |
| UPPLIES** |                                                          |
| (*10 CFR  |                                                          |
| 600.135,  |                                                          |
| 600.233,  |                                                          |
| 600.324,  |                                                          |
| or FDP    |                                                          |
| General   |                                                          |
| Terms and |                                                          |
| C         |                                                          |
| onditions |                                                          |
| No. 35,   |                                                          |
| as        |                                                          |
| a         |                                                          |
| pplicable |                                                          |
| )*        |                                                          |
+-----------+----------------------------------------------------------+
| > Does    |                                                          |
| > the     |                                                          |
| >         |                                                          |
|  residual |                                                          |
| >         |                                                          |
| inventory |                                                          |
| > of      |                                                          |
| > unused  |                                                          |
| >         |                                                          |
|  supplies |                                                          |
| > exceed  |                                                          |
| > \$5,000 |                                                          |
| > in      |                                                          |
| > total   |                                                          |
| >         |                                                          |
| aggregate |                                                          |
| > value?  |                                                          |
| > No Yes  |                                                          |
| > *(if    |                                                          |
| >         |                                                          |
|  **yes**, |                                                          |
| > check   |                                                          |
| > block   |                                                          |
| > below)* |                                                          |
+-----------+----------------------------------------------------------+
| > The     |                                                          |
| >         |                                                          |
|  supplies |                                                          |
| > will be |                                                          |
| > used on |                                                          |
| > another |                                                          |
| >         |                                                          |
| Federally |                                                          |
| >         |                                                          |
| sponsored |                                                          |
| >         |                                                          |
|  activity |                                                          |
| > *(List  |                                                          |
| >         |                                                          |
|  Activity |                                                          |
| > and     |                                                          |
| > Federal |                                                          |
| >         |                                                          |
| Agency).* |                                                          |
| >         |                                                          |
| >         |                                                          |
| > The     |                                                          |
| >         |                                                          |
|  supplies |                                                          |
| > will be |                                                          |
| > sold or |                                                          |
| >         |                                                          |
|  retained |                                                          |
| > for use |                                                          |
| > on      |                                                          |
| > non-    |                                                          |
| Federally |                                                          |
| >         |                                                          |
| sponsored |                                                          |
| > a       |                                                          |
| ctivities |                                                          |
| > and the |                                                          |
| >         |                                                          |
| Recipient |                                                          |
| > will    |                                                          |
| > c       |                                                          |
| ompensate |                                                          |
| > DOE for |                                                          |
| > its     |                                                          |
| > share   |                                                          |
| > of the  |                                                          |
| > sales   |                                                          |
| >         |                                                          |
|  proceeds |                                                          |
| > (or     |                                                          |
| >         |                                                          |
|  estimate |                                                          |
| > of      |                                                          |
| > current |                                                          |
| > fair    |                                                          |
| > market  |                                                          |
| > value). |                                                          |
| > Attach  |                                                          |
| > a list  |                                                          |
| > of the  |                                                          |
| >         |                                                          |
|  supplies |                                                          |
| > and     |                                                          |
| >         |                                                          |
|  complete |                                                          |
| > the     |                                                          |
| >         |                                                          |
| following |                                                          |
| > Wor     |                                                          |
| ksheet*:* |                                                          |
|           |                                                          |
| Sale      |                                                          |
| proceeds  |                                                          |
| or        |                                                          |
| estimate  |                                                          |
| of        |                                                          |
| current   |                                                          |
| fair      |                                                          |
| market    |                                                          |
| val       |                                                          |
| ue**..... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| .......** |                                                          |
| \$\_\_\_  |                                                          |
| \_\_\_\_\ |                                                          |
| _\_\_\_\_ |                                                          |
|           |                                                          |
| P         |                                                          |
| ercentage |                                                          |
| of        |                                                          |
| Federal   |                                                          |
| part      |                                                          |
| icipation |                                                          |
| **......  |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| .......** |                                                          |
| \_\_\     |                                                          |
| _\_\_\_\_ |                                                          |
| \_\_\_\_% |                                                          |
|           |                                                          |
| Federal   |                                                          |
| share     |                                                          |
| **...     |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| .......** |                                                          |
| \$\_\_\_  |                                                          |
| \_\_\_\_\ |                                                          |
| _\_\_\_\_ |                                                          |
|           |                                                          |
| Selling   |                                                          |
| and       |                                                          |
| handling  |                                                          |
| allowance |                                                          |
| **....    |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| .......** |                                                          |
| \$\_\_\_  |                                                          |
| \_\_\_\_\ |                                                          |
| _\_\_\_\_ |                                                          |
|           |                                                          |
| **Amount  |                                                          |
| to be     |                                                          |
| remitted  |                                                          |
| to DOE    |                                                          |
| ....      |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| ......... |                                                          |
| .......** |                                                          |
| \$\_\_\_  |                                                          |
| \_\_\_\_\ |                                                          |
| _\_\_\_\_ |                                                          |
+-----------+----------------------------------------------------------+
|           |                                                          |
+-----------+----------------------------------------------------------+

+---------+-------------------------------------------------+----+----+
| **U.S.  |                                                 |    |    |
| DEP     |                                                 |    |    |
| ARTMENT |                                                 |    |    |
| OF      |                                                 |    |    |
| E       |                                                 |    |    |
| NERGY** |                                                 |    |    |
|         |                                                 |    |    |
| **FI    |                                                 |    |    |
| NANCIAL |                                                 |    |    |
| ASSIS   |                                                 |    |    |
| TANCE** |                                                 |    |    |
|         |                                                 |    |    |
| **P     |                                                 |    |    |
| ROPERTY |                                                 |    |    |
| C       |                                                 |    |    |
| LOSEOUT |                                                 |    |    |
| C       |                                                 |    |    |
| ERTIFIC |                                                 |    |    |
| ATION** |                                                 |    |    |
+---------+-------------------------------------------------+----+----+
| **III.  |                                                 |    |    |
| REAL    |                                                 |    |    |
| PROP    |                                                 |    |    |
| ERTY:** |                                                 |    |    |
| *(Real  |                                                 |    |    |
| E       |                                                 |    |    |
| state - |                                                 |    |    |
| 10 CFR  |                                                 |    |    |
| 6       |                                                 |    |    |
| 00.132, |                                                 |    |    |
| /6      |                                                 |    |    |
| 00.231, |                                                 |    |    |
| 6       |                                                 |    |    |
| 00.321, |                                                 |    |    |
| or FDP  |                                                 |    |    |
| General |                                                 |    |    |
| Terms   |                                                 |    |    |
| and     |                                                 |    |    |
| Con     |                                                 |    |    |
| ditions |                                                 |    |    |
| No. 32, |                                                 |    |    |
| as      |                                                 |    |    |
| appli   |                                                 |    |    |
| cable)* |                                                 |    |    |
| No Yes  |                                                 |    |    |
| *(If    |                                                 |    |    |
| *       |                                                 |    |    |
| *yes,** |                                                 |    |    |
| c       |                                                 |    |    |
| omplete |                                                 |    |    |
| A --C)* |                                                 |    |    |
+---------+-------------------------------------------------+----+----+
| A.      |                                                 |    |    |
|  **Desc |                                                 |    |    |
| ription |                                                 |    |    |
|     of  |                                                 |    |    |
|         |                                                 |    |    |
|    Real |                                                 |    |    |
|         |                                                 |    |    |
|    Prop |                                                 |    |    |
| erty:** |                                                 |    |    |
+---------+-------------------------------------------------+----+----+
| B.  **C |                                                 |    |    |
| omplete |                                                 |    |    |
|         |                                                 |    |    |
| Address |                                                 |    |    |
|     of  |                                                 |    |    |
|         |                                                 |    |    |
|    Real |                                                 |    |    |
|         |                                                 |    |    |
|    Prop |                                                 |    |    |
| erty:** |                                                 |    |    |
|         |                                                 |    |    |
| > **C.  |                                                 |    |    |
| >       |                                                 |    |    |
|  Period |                                                 |    |    |
| > of    |                                                 |    |    |
| >       |                                                 |    |    |
| Federal |                                                 |    |    |
| > I     |                                                 |    |    |
| nterest |                                                 |    |    |
| > in    |                                                 |    |    |
| > the   |                                                 |    |    |
| > Pr    |                                                 |    |    |
| operty: |                                                 |    |    |
| > From  |                                                 |    |    |
| > \_    |                                                 |    |    |
| \_\_\_\ |                                                 |    |    |
| _\_\_\_ |                                                 |    |    |
| > To    |                                                 |    |    |
| > \_\_  |                                                 |    |    |
| \_\_\_\ |                                                 |    |    |
| _\_\_** |                                                 |    |    |
| >       |                                                 |    |    |
| (Unless |                                                 |    |    |
| > the   |                                                 |    |    |
| > award |                                                 |    |    |
| > sp    |                                                 |    |    |
| ecifies |                                                 |    |    |
| > oth   |                                                 |    |    |
| erwise, |                                                 |    |    |
| > the   |                                                 |    |    |
| >       |                                                 |    |    |
| Federal |                                                 |    |    |
| > I     |                                                 |    |    |
| nterest |                                                 |    |    |
| > in    |                                                 |    |    |
| > the   |                                                 |    |    |
| > p     |                                                 |    |    |
| roperty |                                                 |    |    |
| > ends  |                                                 |    |    |
| > when  |                                                 |    |    |
| > the   |                                                 |    |    |
| > award |                                                 |    |    |
| >       |                                                 |    |    |
| project |                                                 |    |    |
| >       |                                                 |    |    |
|  period |                                                 |    |    |
| > ends. |                                                 |    |    |
| > )     |                                                 |    |    |
+---------+-------------------------------------------------+----+----+
| >       |                                                 |    |    |
|  **D.** |                                                 |    |    |
| >       |                                                 |    |    |
|  **Disp |                                                 |    |    |
| osition |                                                 |    |    |
| > Pre   |                                                 |    |    |
| ference |                                                 |    |    |
| > Req   |                                                 |    |    |
| uest.** |                                                 |    |    |
| > If    |                                                 |    |    |
| > the   |                                                 |    |    |
| >       |                                                 |    |    |
|  period |                                                 |    |    |
| > of    |                                                 |    |    |
| >       |                                                 |    |    |
| Federal |                                                 |    |    |
| > I     |                                                 |    |    |
| nterest |                                                 |    |    |
| > in    |                                                 |    |    |
| > the   |                                                 |    |    |
| > p     |                                                 |    |    |
| roperty |                                                 |    |    |
| >       |                                                 |    |    |
| exceeds |                                                 |    |    |
| > the   |                                                 |    |    |
| >       |                                                 |    |    |
| project |                                                 |    |    |
| >       |                                                 |    |    |
| period, |                                                 |    |    |
| > check |                                                 |    |    |
| > one   |                                                 |    |    |
| > of    |                                                 |    |    |
| > the   |                                                 |    |    |
| > fo    |                                                 |    |    |
| llowing |                                                 |    |    |
| >       |                                                 |    |    |
|  blocks |                                                 |    |    |
| > to    |                                                 |    |    |
| > i     |                                                 |    |    |
| ndicate |                                                 |    |    |
| > your  |                                                 |    |    |
| > disp  |                                                 |    |    |
| osition |                                                 |    |    |
| > pref  |                                                 |    |    |
| erence: |                                                 |    |    |
| >       |                                                 |    |    |
| > T     |                                                 |    |    |
| ransfer |                                                 |    |    |
| > p     |                                                 |    |    |
| roperty |                                                 |    |    |
| > to    |                                                 |    |    |
| >       |                                                 |    |    |
| another |                                                 |    |    |
| >       |                                                 |    |    |
| Federal |                                                 |    |    |
| >       |                                                 |    |    |
|  award. |                                                 |    |    |
| >       |                                                 |    |    |
| > Sell  |                                                 |    |    |
| > and   |                                                 |    |    |
| > com   |                                                 |    |    |
| pensate |                                                 |    |    |
| > DOE.  |                                                 |    |    |
| >       |                                                 |    |    |
| >       |                                                 |    |    |
|  Return |                                                 |    |    |
| > to    |                                                 |    |    |
| > DOE.  |                                                 |    |    |
| >       |                                                 |    |    |
| >       |                                                 |    |    |
|  Retain |                                                 |    |    |
| > title |                                                 |    |    |
| > and   |                                                 |    |    |
| > com   |                                                 |    |    |
| pensate |                                                 |    |    |
| > DOE   |                                                 |    |    |
| > for   |                                                 |    |    |
| > its   |                                                 |    |    |
| > share |                                                 |    |    |
| > of    |                                                 |    |    |
| > the   |                                                 |    |    |
| >       |                                                 |    |    |
| current |                                                 |    |    |
| > fair  |                                                 |    |    |
| >       |                                                 |    |    |
|  market |                                                 |    |    |
| > value |                                                 |    |    |
| > of    |                                                 |    |    |
| > the   |                                                 |    |    |
| > pr    |                                                 |    |    |
| operty. |                                                 |    |    |
| >       |                                                 |    |    |
| > .     |                                                 |    |    |
| >       |                                                 |    |    |
| > **Ce  |                                                 |    |    |
| rtifica |                                                 |    |    |
| tion:** |                                                 |    |    |
| > I     |                                                 |    |    |
| >       |                                                 |    |    |
| certify |                                                 |    |    |
| > to    |                                                 |    |    |
| > the   |                                                 |    |    |
| > best  |                                                 |    |    |
| > of my |                                                 |    |    |
| > kn    |                                                 |    |    |
| owledge |                                                 |    |    |
| > and   |                                                 |    |    |
| >       |                                                 |    |    |
|  belief |                                                 |    |    |
| > that  |                                                 |    |    |
| > all   |                                                 |    |    |
| > info  |                                                 |    |    |
| rmation |                                                 |    |    |
| > pr    |                                                 |    |    |
| esented |                                                 |    |    |
| > in    |                                                 |    |    |
| > this  |                                                 |    |    |
| >       |                                                 |    |    |
|  report |                                                 |    |    |
| > is    |                                                 |    |    |
| > true, |                                                 |    |    |
| >       |                                                 |    |    |
| correct |                                                 |    |    |
| > and   |                                                 |    |    |
| > co    |                                                 |    |    |
| mplete, |                                                 |    |    |
| > and   |                                                 |    |    |
| > cons  |                                                 |    |    |
| titutes |                                                 |    |    |
| > a     |                                                 |    |    |
| > m     |                                                 |    |    |
| aterial |                                                 |    |    |
| >       |                                                 |    |    |
| represe |                                                 |    |    |
| ntation |                                                 |    |    |
| > of    |                                                 |    |    |
| > fact  |                                                 |    |    |
| > upon  |                                                 |    |    |
| > which |                                                 |    |    |
| > the   |                                                 |    |    |
| >       |                                                 |    |    |
| Federal |                                                 |    |    |
| > gov   |                                                 |    |    |
| ernment |                                                 |    |    |
| > may   |                                                 |    |    |
| > rely. |                                                 |    |    |
+---------+-------------------------------------------------+----+----+
| Name    | Signature                                       | T  | Da |
|         |                                                 | it | te |
| **      | **     **                                       | le |    |
|      ** |                                                 |    |    |
|         |                                                 |    |    |
|         |                                                 |    |    |
|         |                                                 |    |    |
+---------+-------------------------------------------------+----+----+

**U.S. DEPARTMENT OF ENERGY**

**FINANCIAL ASSISTANCE**

**PROPERTY CLOSEOUT CERTIFICATION**

+----------------------+---+---------------------+---+---------------------+
| **To be completed by |   |                     |   |                     |
| the Department of    |   |                     |   |                     |
| Energy:**            |   |                     |   |                     |
+----------------------+---+---------------------+---+---------------------+
| **[DOE PROPERTY      |   |                     |   |                     |
| DISPOS               |   |                     |   |                     |
| ITION]{.underline}** |   |                     |   |                     |
|                      |   |                     |   |                     |
| **Negative Report**  |   |                     |   |                     |
|                      |   |                     |   |                     |
| **Real Property:**   |   |                     |   |                     |
|                      |   |                     |   |                     |
| **Equipment:**       |   |                     |   |                     |
|                      |   |                     |   |                     |
| **Supplies:**        |   |                     |   |                     |
+----------------------+---+---------------------+---+---------------------+
| **Property           |   | **Signature**       |   | **Date**            |
| Management Official  |   |                     |   |                     |
| Name**               |   |                     |   |                     |
+----------------------+---+---------------------+---+---------------------+