''No further loan funds may be paid out under this program unless this report 

is completed and filed as required (7 U.S.C. 901 et seq.). ''

DATE

SHEET OF SHEETS

PROJECT DESIGNATION

NAME OF ENGINEER

U. S. DEPARTMENT OF AGRICULTURE 

RURAL UTILITIES SERVICE

FINAL INVENTORY 

TELEPHONE FORCE ACCOUNT CONSTRUCTION

TO: U. S. DEPARTMENT OF AGRICULTURE, RUS, WASHINGTON 25, D.C

INSTRUCTIONS: See reverse side.

CERTIFICATE OF ENGINEER 

1. The construction provided for pursuant to the

* Force Account Construction Proposal Dated

* Force Account Construction Estimate(s) Nos.

including all approved amendments, (hereinafter called the ''Project'') by

(''Owner'') has been completed as of 20 , and is in all

respects in strict compliance with the provisions of the Loan Contract and the plans, specifications, maps and drawings and all modifications 

thereof.

2. The Final Inventory attached hereto and made a part hereof is a complete and accurate summary of all units of construction in the Project and 

of all work performed by the Owner for the Project.

3. The staking sheets and tabulation of staking sheets, upon which the Final Inventory is based show the accurate location, number, and kind of 

all units of construction of the Project.

4. All defects in workmanship and materials reported during the period of construction of the Project have been corrected.

5. The total cost of construction of the Project as completed is

Dollars ($ ). The Project consists of facilities shown on the

Statement of Construction which is true and correct and which is attached hereto and made a part hereof.

BORROWER'S ENGINEER

I

By

DATE

TITLE

CERTIFICATE OF BORROWER

I certify that the actual costs of construction and the total funds required as reflected herein are the actual costs of construction and the actual 

funds required as shown in the individual accounts and costs sheets maintained as part of the permanent records of this organization. I further 

certify that payment has been made to all persons who have furnished labor for the project.

DATE OWNER

By PRESIDENT

THE NET CHARGE DUE TO RETIREMENT IS:

Original cost, (Col. (14) Form 817b)

Cost of removal, (Col. (12) Form 817b)

TOTAL

Deduct salvage (Col. (19) Form 817c Plus Col. (21) Form 817c)

Net charge due to retirement, (Grand Total Col. (14) Form 817b plus Grand Total Col. (12)

Form 817b Less Grand Total Col. (19) Form 817c less Grand Total Col. (21) Form 817c)

RUS FORM 817 R E V . 6-60 *Check applicable item.

- -

I, the undersigned engineer of the above-designated Rural Utilities Service Project do hereby certify that:

- -

- -

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB 

control number. The valid OMB control number for this information collection is 0572-0059. The time required to complete this information is estimated to average 2 hours per response, 

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of nformation.
 The engineer will prepare 4 copies of forms covering 

all data in Col. (1) through Col. (12), Cols. (15) and (16).

Cols. (1), (2) ... From tabulation of staking sheets

Cols. (3), (4) ... From force account proposal or estimates

Col. (5) Col. (3) + Col. (4)

 The assembly units are to be grouped according to the 

plant account classification (see applicable system of 

accounts). The plant account number and title should head 

each group. For the purpose of this inventory:

Col. (6) Col. (1) x Col. (3)

Col. (7) Col. (1) x Col. (4)

Col. (8) Col. (1) x Col. (5)

Col. (9) From tabulation of staking sheets

Col. (10) From tabulation of staking sheets

From Force account proposal or estimates 

Col. (9) X Col. (11) 

From owner's record

Col. (9) x Col. (13) 

Prepared by engineer 

Prepared by engineer 

From owner's record 

From owner's record

1. Assembly units containing pin-type insulators (i.e. single Col. (I 1)

groove, double groove transposition, etc.) are to be listed 

under the account determined by the other mat- erials in the 

assembly unit.

Col. (12)

Col. (13)

Col. (14)

Col. (15)

2. As a sub-item under ''Pole Lines,'' list the number of Col. (16)

pin-type insulators (i.e., single groove, double groove 

transposition, etc.) included in the assembly units in that 

account, segregated by type and item cost. (Do not extend total 

cost.)

Col. (17) .

Col. (18)

Col. (17) x Col. (18) 

From owner's record

Col. (19)

Col. (20)

Col. (21) From owner's record

To be listed at end of inventory for 

Col's. (6), (7), (8) and (12).

 Upon completion of above, the engineer will deter- Total Costs

mine the following:

(A) Total Estimated Cost in each column

based on inventory unit prices

(B) Total Actual Cost in each column from

 The total cost of construction of the Project, Item 5 

of the of the certificate, is the sum of the Total Actual 

Cost of Col. (8) + Col. (12). owner's record

(C) Value of Reused Materials (Col. (7) only) ...

from owner's record The Final Inventory, together with all other final 

papers, will then be submitted to RUS for approval. (D) Total funds required in each column

Same Total (B) fi)r Col. (6)

 Total (B) Col. (7) -Total (C)Col.(7) 

Sum Total Funds Cols. (6) + (7) 

Same Total (B) for Col. (12)

Col. (6)

Col. (7) Upon approval of the inventory by RUS, one copy will 

be returned to the owner. When required, the owner will 

complete Columns (13) and (14) and Columns (17) through 

(21) together with the calculation of ''Net Charge Due to 

Retirement''

Col. (8)

Col. (12) ...

RUS FORM 817 REV. 6-60