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Exhibit"D" <br /> 2019 CDBG Subrecipient Agreement <br /> City of Everett EVERETT <br /> WASHINGTON <br /> Community Development Block Grant <br /> 2019 Program Year Reimbursement Request <br /> Agency: <br /> Program: <br /> Mailing Address: <br /> The expenditures listed below were incurred during the following time period for the <br /> purpose of <br /> Contact name/phone for questions on expenditures: <br /> THE CITY OF EVERETT CANNOT ACCEPT ELECTRONIC REIMBURSEMENTS.ALL REQUESTS FOR PAYMENT MUST HAVE <br /> ORIGINAL SIGNATURE.This form must match the project budget on file and be accompanied by source <br /> documentation. Failure to do so may result in delay of reimbursement. <br /> Category Budget Current Period Total Expenses to Balance <br /> Expenditures Date Remaining <br /> Request for Payment: The undersigned Program Manager certifies that the information submitted in support of this <br /> Request for Reimbursement is true, accurate and complete to the best of their knowledge. <br /> Approved for Payment: Date: <br /> Printed Name and Title of Program Manager: <br /> Please return this form, with original signature, to:Rebecca McCrary, Office of Community, Planning and Economic <br /> Development, 2930 Wetmore Avenue,Suite 8A, Everett, WA 98201 <br /> City Use Only:Vendor Number[366271 <br /> 2019 Grant Amount: [$135,000.00] <br />