395b RUS Form 395b - Certificate of Completion

OMB Control No. 0572-xxxx

Expiration Date: xx, 20xx

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-NEW. The time required to complete this information is estimated to average 30 minutes 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 information.

CERTIFICATE OF COMPLETION

(Not Including Installation)

	PROJECT DESIGNATION

In connection with the above referenced RUS financed project, the undersigned certify to the best of their respective knowledge and belief that:

1.	The equipment and materials, provided for pursuant to Contract No.						dated
				,	including all approved amendments, (hereinafter called
"Equipment") between
(Buyer) and

(Seller) have been delivered and are in all respects in strict compliance with the provisions of the contract, including specifications, drawings and all modifications thereof.

2. The Equipment has been installed and all acceptance tests have been made on the Equipment and the results were satisfactory.

3. The total cost of the Equipment in accordance to the contract and approved amendments thereto is

				Dollars
$		.	Including $__________ in taxes paid by the Seller and $____________ in taxes paid by the Buyer

Dated this

day of

,

20

.

NAME OF BUYER				NAME OF ENGINEER
By				By
	SIGNATURE OF BUYER				SINGNATURE OF ENGINEER

RUS FORM 395b (Rev. 20)