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City of Everett Human Needs Grant <br /> January 1 through December 31, 2017 <br /> Exhibit C: Request for Reimbursement <br /> Organization: Friends of Youth <br /> Program Name: New Ground Everett Transitional Living Program <br /> Mailing Address: 13116 NE 132nd Street, Kirkland WA 98034-2306 <br /> Report Month and Year: <br /> The expenditures made during the report month were for the specific purpose of: <br /> Define one unit of service: <br /> During this billing period a total of units of service were provided to <br /> residents of the City of Everett using these grant funds. <br /> Contact name/phone for questions on invoice: <br /> Expenditures <br /> Category Total Budget Current Report Total Expenses Balance <br /> Period Billed to Date Remaining <br /> Salaries/Wages <br /> Benefits <br /> Office and Operating <br /> Supplies <br /> Professional Services <br /> Other: <br /> • <br /> Total $5,500 <br /> Request for Payment: The undersigned Program Manager certifies that the information submitted in support <br /> of this Request for Reimbursement is true, accurate and complete to the best of their knowledge. <br /> Program Manager Signature Date <br /> Approved for Payment <br /> Rebecca A. McCrary Date <br /> Manager, Housing and Community Development Programs <br /> GL Code: 009-5000199410 <br /> Vendor No: 05291 (City use only) <br />