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<br />Value of Equipment (Attach completed and signed Form C) <br /> <br /> Total Yearly <br />Description of item(s) Value <br /> . <br />I Total Value <br /> <br />Value of Supplies/Materials (Attach completed and signed Form D) <br /> <br /> Total Yearly, <br />Description of item(s) , Value <br />.1 Total Value <br /> <br />Value of Other Resources (Attach completed and signed Form E) <br /> <br /> Total Yearly <br />Description of item(s) Value <br />. <br />I Total Value <br /> <br />OVERALL TOTAL VALUE <br /> <br />150:1 LUJ <br /> <br />On behalf of <br /> <br />we agree to <br /> <br />(Name of Agency) <br />contribute the above in-kind resources to support the Family Nutrition Program during the project year <br />through September 30, 2004. We certify that we have public, non-federal funds/services available for <br />matching the Family Nutrition Program and that these funds are not used to match other Federal <br />programs. <br /> <br />~~l~-i1 aJ. <br /> <br />Signature - Agency Director <br /> <br />e5LRt{~ <br />Title . <br /> <br />Lf- d- s:=:- 0 .3 <br />Date - <br /> <br />revised 2/03 <br /> <br />C :Iwpdocslformslcontri bsp. 03 <br />