Food Bank Year-End Summary Report

Food Bank Year-End Summary Report
Food Bank Name
Total number of Pantries
Shared-maintenance Fee
Number of Pantries that received dog food last year
Number of Pantries receiving Jazzy’s Place grants
Total dog food pounds
Amount of dog food distributed this year from your own product-sourcing
Total amount of pet food reported to Feeding America last year
Account balance at beginning of this year
Account balance at end of year
I certify that the Jazzy’s Place grant will be only used to offset the shared-maintenance costs. Grants will not be used for any direct purchases of human or dog/pet food but used solely to offset what Pantries would otherwise incur to cover costs for our product sourcing efforts.
List of all food Pantries participating in the Jazzy’s Place grant program: Dog Food Pantry Name Pantry$ Amount Lbs. Delivered
Signature
Date

MonthDayYear
Date
Print Name
Title
Email Address
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List all food Pantries participating in the Jazzy’s Place grant program*

	Pantry Name	Pantry #	Dog Food Lbs. Delivered	$ Amount
1
2