CPA Grantee Reimbursement Request.xlsx[Please put your logo and letterhead here]
Date:
Grant Invoice Number:
Grantee Name:
Project Name:
City Contract Num:
Remittance Address:
Requestor Name:
The grantee certifies that work has been completed on the above referenced CPA project
Invoices documenting work are listed below and enclosed/attached.
Grantee reimbursement is is requested pursuant to the Grant contract or MOU
Invoice Number
Total
Vendor
[Number of your choice]
Description
Amount
Requested
this Invoice
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Bill To:
Total
Requested
this Invoice
Notes
City of Northampton
Community Preservation
c/o Planning & Sustainability
210 Main St, City Hall
Northampton, MA 01060
0