Fillable City of Roswell Special Event Funding Reimbursement (City of Roswell)

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City of Roswell Special Event Funding Reimbursement (City of Roswell)

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BROWSE CITY OF ROSWELL (NM) FORMS

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City of Roswell – Special Event Funding – Reimbursement
NAME OF EVENT:
DATE(S) OF EVENT:
ORGANIZATION SPONSORING EVENT:
MAKE CHECK PAYABLE TO:
MAILING ADDRESS / CITY / STATE / ZIP:
NAME OF CONTACT PERSON:
PHONE:
CELL PHONE:
E-MAIL ADDRESS (optional):
Vendor and/or description of use of funds (print) Invoice Amount EE City Use Only
(example: Acme Printers / posters, brochures) 300.00
Awarded Amount
1
Previously Rec’d Amt
2
Remaining Balance
3
Requested – Amt
4
Adjustment
5
Adjusted Amount
6
Balance
7
8
Enter total from extra sheet (if any) on #9
9
TOTAL
50% of Total shown
List each vendor and/or description of the use of funds separately with the amount, use additional paper if necessary.
Requested amount must be equal to or less than 50% of the total amount of invoices listed (and attached) and no more than the amount
awarded.
Requested amount must be 25% (1/4) or more of the maximum awarded amount, exception on final request.
Final request for reimbursement is due sixty (60) days following the last day of the event.
Attach invoices, proof of payment (check copy or credit card receipt copy) and appropriate documentation to this request.
Submit to Public Affairs department to be approved and processed for payment.
Approved reimbursement amount may or may not be same as amount requested.
Expenses which are deemed as not eligible will be denied and the approved amount may be lower than the requested amount.
Requests may not be approved on the same day they are received.
Requests approved no later than Tuesday will normally be processed in the next A/P check run.
See Policy for Reimbursement request details.
Request reimbursement in the amount of $
Requ
ested by: ____________________________________________________date________________
Please mail or call when ready: _______________________________________phone #______________
* * * Official City Use * * *
Request Received (date)__________________________ Approved Amount: _$______________________
Approved by:________________________________________________ date________________
Check # _______________ Check date ________________
Check released to (signature):________________________________Date check obtained or mailed _______________
(For Final Reimbursement Request - Last day of Event ________________________ # of days_________________ )
Revised May 2018
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City of Roswell Special Event Funding Reimbursement (City of Roswell)

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Completed 4 August 2020

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