Lake County Community Development
Payment Request - Voucher Form
Grant Number
*
Number on Lake County grant agreement
Community Partner
*
Organization
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Person submitting request
*
First Name
Last Name
Email
*
example@example.com
Payment request for:
*
Grant Manager
*
Please Select
Albino, Yazmin
Jeffries, Pamela
Raphaelson, Penni
Strezo, Dominic
Tellez, Eric
Payment request summary
*
Browse Files
Drag and drop files here
Choose a file
Spreadsheet/table that support the total payment request.
Cancel
of
Supporting documentation
*
Browse Files
Drag and drop files here
Choose a file
Invoice copies, payroll registers, etc
Cancel
of
Proof of payment
*
Browse Files
Drag and drop files here
Choose a file
General ledger, check register or check copy
Cancel
of
Submit
Should be Empty: