HomeMy WebLinkAboutIFRO Rexburg Invoice Template FY221. Subrecipient:
2. Invoice Date:
3. Invoice Period:
In accordance with the terms of the subaward agreement, I / we request reimbursement as follows:
Budget Line Item
Salaries/Fringe
Travel
Supplies
Equipment
Contractual*
Other
Indirect
TOTAL
*Copies of invoices must be attached to this request for reimbursement.
Budget Line Item
Salaries/Fringe
Travel
Supplies
Equipment
Contractual*
Other
Indirect
TOTAL
13. Subrecipient's Authorized Signature:
15. Print Signature Name:
17. Warrants Payable To (Name):
18. Mailing Address:
19. Contact Name for Billing Questions:
21. Contact Email Address:
For DEQ Internal Use Only:
I find this request to be consistent with the Subaward Agreement and all funding conditions have been met.
22. Project Coord. Signature:
24. Grants/Contracts Manager Signature:
City of Rexburg
DEQ Funds Budget
0
0
0
0
10000
0
0
10000
Matching Contribution
0
0
0
0
1900
0
0
1900
Funds Previously Requested to Date
0
Funds Previously Committed to Date
0
Funds Requested This Invoice
0
Funds Committed This Invoice
0
4. Subaward #:
5. Invoice #:
Total Requested
0
0
0
0
0
0
0
0
Total Committed
0
0
0
0
0
0
0
0
14. Date:
16. Title:
20. Phone:
23. Date:
25. Date:
Total Remaining
0
0
0
0
10000
0
0
10000
Total Remaining
0
0
0
0
1900
0
0
1900