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MUNICIPAL LEASE-PURCHASE AGREEMENT – PAGE 15 <br />ESCROW AGREEMENT - SCHEDULE 1 <br />MUNICIPAL LEASE-PURCHASE AGREEMENT No.7768 (THE "AGREEMENT") <br /> BY AND BETWEEN <br />Lessor, Government Capital Corporation and Lessee, County of Kittitas <br />Dated as of May 2, 2017 <br /> <br /> <br />ESCROW DISBURSEMENT REQUEST FORM <br /> <br />BOKF, NA, acting as escrow agent (the "Agent") under the Escrow Agreement dated as of May 2, 2017 (Escrow Date), by and among <br />the Agent, Government Capital Corporation as Lessor and County of Kittitas as Lessee, is hereby requested to pay to the person or <br />corporation designated below as Payee the sum set forth below in payment of the acquisition and installation costs of the property <br />described below. The amount shown below is due and payable under the invoice of Payee with respect to the described property and <br />has not formed the basis of any prior request for payment. <br /> <br />PAYEE: ______________________________________________________________________________________________ <br /> <br />AMOUNT: ____________________________________________________________________________________________ <br /> <br />DESCRIPTION OF PROPERTY: ___________________________________________________________________________ <br /> <br />INVOICE #_________________________________ DATED: ___________________________________________________ <br /> <br /> <br />Indicate Method for Payment Disbursement: <br /> <br />______Overnight Check *** _____Regular Mail Check ______Wire Funds <br /> <br />Mailing Address: ___________________________ Wire Instructions: ______________________________ <br /> <br />__________________________ ______________________________ <br /> <br />(***Please note that there might be a fee charged for overnight delivery. This fee will be <br /> deducted from the Escrow Balance before disbursement is made.) <br /> <br />Lessee: County of Kittitas <br /> <br /> <br /> <br />By: _____________________________________________ <br />Jerald V. Pettit, County Auditor <br /> <br />Lessor: Government Capital Corporation or its assigns <br /> <br /> <br /> <br />By: _________________________________________________ <br />Authorized Signer <br /> <br />ACCEPTANCE CERTIFICATE <br /> <br />County of Kittitas as Lessee under that certain Municipal Lease-Purchase Agreement dated as of May 2, 2017 ("Agreement Date") <br />(the "Lease"), hereby acknowledges receipt in good condition of all the property described on the attached Vendor Invoice(s), hereby <br />accepts such property, and hereby certifies that Lessor has fully and satisfactorily performed all covenants and conditions to be <br />performed by it under the Lease with regard to such property, that such property is fully insured in accordance with Section 10 of the <br />Lease and that such property constitutes all or a portion of the Property as that term as defined in the Lease. <br /> <br />Date: _____________________________, 2017. <br /> <br />By Lessee: <br /> <br /> <br />_____________________________________________ <br />Jerald V. Pettit, County Auditor <br /> <br /> For Lessee: County of Kittitas <br />