Laserfiche WebLink
<br />, <br /> <br />Value of Equipment (Attach completed and signed Form C) <br /> <br /> Total Yearly <br />Description of item(s) Value <br />,-, <br />. , T Total Value <br /> <br />Value of Supplies/Materials (Attach completed and signed Form D) <br /> <br />."'6 Total Yearly, <br />Description of item(s) Value <br />. -.. ..... .... , <br />I 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 />, I Total Value <br /> , <br /> <br />./ OVERALL TOTAL VALUE <br /> <br />1535,001 <br /> <br />~CU\(~ Rtn~) ~n!nlf b <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 /> <br /> <br />dA~. <br /> <br />Signature - Agency Director <br /> <br />On behalf of <br /> <br />we agree to <br /> <br />~fi2,4/1'~/~. . ~~5 <br /> <br />~e' Da~ <br /> <br />revised 2/03 <br /> <br />C:lwpdocslformslcontribsp.03 <br />