Fillable CITY OF MASSILLON, OHIO COMMUNITY DEVELOPMENT BLOCK GRANT (City of Massillon)

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CITY OF MASSILLON, OHIO COMMUNITY DEVELOPMENT BLOCK GRANT (City of Massillon)

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BROWSE CITY OF MASSILLON (OH) FORMS

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Page 1 of 2
CITY OF MASSILLON, OHIO
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
REQUISITION FOR FUNDS - SUBRECIPIENT PROGRAMS
Date: Requisition No.:
Agency Name:
Agency Address:
Name of Person Completing Requisition:
REQUISITION SUMMARY
Amount of CDBG Contract Award
Total CDBG Payments to Date
Amount Requested Today
Balance of Contract Amount
Total Amount Being Requisitioned at This Time:
PLEASE ATTACH THE FOLLOWING ITEMS:
1.) Attach reimbursement documentation records: Receipts, timesheets, payroll records, etc.
2.) Attach Direct Benefit Activities Worksheet (If Applicable or Provided)
CDBG CONTRACT BUDGET
BUDGET LINE ITEM
CDBG BUDGET AMOUNT
ESTIMATED CURRENT
EXPENDITURES
TOTAL CDBG
EXPENDITURES
TO DATE
TOTAL OPERATING COSTS
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Page 2 of 2
NARRATIVE PROGRESS REPORT
Progress for The Following Period: TO
Please provide a brief narrative report on the accomplishments and progress of this program
activity during the time period since the last requisition for funds was submitted to the City.
Wherever possible, provide quantifiable data regarding program progress: i.e., number of clients
served, etc. (Attach additional sheets if necessary)
CERTIFICATION
I hereby certify that the amounts above are accurate and represent true and correct costs for the
purpose of providing programs and services as described in the contract scope of services, and
that the amount being requisitioned is needed to defray the cost of program activities as outlined
in the contract budget, and that accurate documentation is attached.
Signature:
Title:
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CITY OF MASSILLON, OHIO COMMUNITY DEVELOPMENT BLOCK GRANT (City of Massillon)

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Completed 20 July 2020

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