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City of Everett <br /> Community Development Block Grant <br /> 2020 Program Year Reimbursement Request <br /> Agency: Cocoon House <br /> Program: WayOut <br /> Mailing Address: 3530 Colby Ave, Everett, WA 98201 <br /> The expenditures listed below were incurred during the following time period for the purpose of <br /> Contact name/email for questions on expenditures: Michael McEntire, <br /> michael.mcentire@cocoonhouse.org <br /> Category Budget Current Period Total Expenses to Balance <br /> Expenditures Date Remaining <br /> TOTAL 10000 <br /> REIMBURSEMENT WITH ORIGINAL SIGNATURE AND BACKUP DOCUMENTATION MUST BE MAILED TO <br /> CITY OF EVERETT AT 2930 WETMORE AVENUE, SUITE 8A, EVERETT, WA 98201. <br /> The undersigned Program Manager certifies that the information submitted in support of this Request <br /> for Reimbursement is true, accurate and complete to the best of their knowledge. <br /> Payment Signature: Date: <br /> Printed Name and Title of Program Manager: <br />