b. Extension Service/FNP grant - Laserfiche WebLink

;. .. J 1 .. ND Family Nutrition Program MAY 232003 Form A ,CONTRIBUTOR SUPPORT FORM October 1, 2003 . September 30, 2004 Your gift of a donation or service is considered a local match to the Federal dollars that support the Family Nutrition Program. Auditing guidelines require that the donor information requested below be kept on . file by our project administrators.' Though your gift of time or use of equipment does not represent an actual cash outlay by your organization to the FNP program, it is necessary for us to place a monetary value on that gift, in order to receive an equivalent amount of Federal funding. Please assign dollar values consistent with your company/agency financial records; when in doubt, please assign a conservative estimate. Thank you very much for your gift toour program. It is essential for our continuing operation to have this . demonstration of local community support. ' County/Site Name of Agency Contact Person Address Phone E-mail ~ ~~~~ t;i;t~~D I ?t9-7~~ _ If) 2- .If) 3 ~ ~., I ~f,J A....J 1:/ ,")'6'/1) 2- ii\" 7B(-;:,,-"fl-'6I'~ .' , t-u pf):>~ tJ Ct', 4- ,Nt .I-{$. Value of Personnel Services (Salary + Fringe Benefits) , .$ Position Hourly value (Name and Title) d~..S7 '.t7 X b = c Estimated hours Total Yearly per year to FNp Value 7::; /';/' 'I --- ,~ , Total Value 7'3~ Value of Physical Space (Attach completed and signed "Facilities Space Valuation Worksheet" _ Form B) and include documentation Total Yearly Value Name of facility t%J ,.9-EJ Total Value / j)tJ. tJ{) (over) C:\wpdocs\forms\contribsp .03