Laserfiche WebLink
Recipient Name : <br /> Address : <br /> Reporting Period : <br /> Grant # : <br /> Date of Real or How was Value Who Made This Cost Per Unit/ Quantity/ Total <br /> Contributor Name Description of Contributed Item(s) or Service Approximate Determined? '(i.'e. Value <br /> Contribution Value of Actual, appraisal, Determination ? Rate of Pay Hour Cosi <br /> Contribution fair market value . <br /> $0 . 00 $ 0 . 00 <br /> $0 . 00 $ 0 . 00 <br /> $0 . 00 $0 . 00 <br /> f <br /> $ 0 . 00 $ 0 . 00 <br /> $ 0 . 00 $0 . 00 <br /> $0 . 00 $0 . 00 <br /> TOTAL <br /> Name of Contributing Organization/ Agency/ Business/ Individual : <br /> Address of Above Contributor : <br /> Printed/ Types Name of Contributor's Authorized Signee : <br /> Signature of Authorized Signee : <br />