Palmer Home Foundation Expense Summary Sheet
Fill the form below accurately. All fields required.
Name of Person Overseeing Grant Useage and Funds
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First Name
Last Name
Organization Name
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Title
*
Phone Number
*
Email
*
example@example.com
Amount of Money Received
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Brief Description Of Proposed Use Of Funds As Stated In Application
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How The Funds Were Used
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Number of Clients Served by this Grant
What Percent of Clients Served by this Grant are Over the Age of 60 and Residing in Kent County
Percentage of funds used for administrative costs
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Please Explain
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Funds Remaining (If Any)
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Date
*
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Month
-
Day
Year
Date
If Applicable / Additional Supporting Documents
*
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I hereby state that the above information is true to the best of my knowledge, information and belief
*
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