Mt Pulaski Economic Development and Planning Board Reimbursement Form

Grant #.
Classification
MOUNT PULASKI ECONOMIC DEVELOPMENT AND PLANNING BOARD COMMUNITY GRANT REIMBURSEMENT FORM
Reimbursements of grant awards per the following:

1. Upon completion of a project or event, recipients must submit:

a. Completed Reimbursement Form

b. Copies of all project or event related invoices or receipts. If granted a percentage of a project or event, that percentage of invoices will be paid up to the maximum amount of the grant.

c. Report of other donations or funds received for the project or event.

d. Photos of completed project work.

2. Submit here or to: Mount Pulaski City Hall-Attention: EDPB Grant Program, 113 S Lafayette St, Mount Pulaski, IL 62548, or email to edpb@cityofmtpulaski.com.

3. Receipts must be submitted by or before 30 days following completion of the project or event. Reimbursement will be issued at EDPB's monthly meetings. Reimbursement request must be received by 4:00 pm on the first Tuesday of the month to be approved and issued at the EDPB meeting on the first Wednesday of the month.

4. A 30-day extension for submitting receipts beyond the original reimbursement period may be asked for and granted if circumstances are deemed to warrant it.

5. After review and approval of the receipts, the EDPB treasurer will pay the amount of approved grant, per receipts and invoices submitted. No payments will be made without corresponding receipts and or invoices.
DATE*

MonthDayYear
Date
Name*
Organization/Business Name*
Address To Mail Payment*
City*
State*
Zip*
Phone*
Email*
example@example.com
Project or Event Name*
Is your project completed?

Date Completed

MonthDayYear
Date
Please answer the following questions when project is complete and submitting final reimbursement.
Did your project goal(s) remain the same?
If no please explain.
Do you feel the community impact/benefit of this project has been met?
If no please explain.
Additional Comments
Did you receive matching funds/support from other organizations/businesses?
Amount
In-Kind support from you or other organizations/businesses?
Value of In Kind Support
Did you receive any other donations or funds for your project?
Amount received

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MOUNT PULASKI ECONOMIC DEVELOPMENT AND PLANNING BOARD COMMUNITY GRANT REIMBURSEMENT FORM