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<br />. <br /> <br />NO Family Nutrition Program <br /> <br />Form A <br /> <br />CONTRIBUTOR SUPPORT FORM <br /> <br />October 1, 2003 - September 30, 2004 <br /> <br />Your gift of a donation or seNice is considered a local match to the Federal dollars that support the Family <br />Nutrition Program. Auditing guidelines require that the donor information requested below be kept on file by our <br />project administrators. Though your gift of time or use of equipment does not represent an actual cash outlay by <br />your organization to the FNP program, it is necessary for us to place a monetary value on that gift, in order to <br />receive an equivalent amount of Federal funding. Please assign dollar values consistent with your <br />company/agency financial records; when in doubt, please assign a conseNative estimate. <br />Thank you very much for your gift to our program. It is essential for our continuing operation to have this <br />demonstration of local community support. <br /> <br />County/Site <br />Name of Agency <br />Contact Person <br />Address <br />Phone <br />E-mail <br /> <br />Cass <br />Fargo Public Schools <br /> <br />415 N 4 St, Fargo <br />701-446-1000 <br /> <br />Value of Personnel Services (Salary + Fringe Benefits) <br /> <br />Position <br />(Name and Title) <br /> <br />Accountant <br /> <br />a X b = C <br />Hourly value Estimated hours Total Yearly <br /> per year to FNP Value <br />1- 18 X 14- .:) 9o?:>, y g <br />15 p 18 X :I't " 5~o3. '-/11 <br />S'/. 5 5 J5 ~ <br /> .. <br />Total Value 80 (P LI. 5/ <br /> <br /> <br />Secretary (types newsletter) <br />Pressman <br /> <br />Value of Physical Space (Attach completed and signed "Facilities Space Valuation Worksheet" Form B) and <br />include documentation <br /> <br /> Total Yearly <br /> Value <br />Name of facility <br />Mad ison <br />Total Value <br />