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Service Representative Grant Financial Report
For Period Ending: __________________
Description of Disbursements VVA Grant State Council Total
Share
Salaries (full time employee(s) __________ __________ __________
Benefits __________ __________ __________
Salaries (part time employee(s) __________ __________ __________
Benefits __________ __________ __________
Office Supplies __________ __________ __________
Telephone __________ __________ __________
Travel __________ __________ __________
Training __________ __________ __________
Other
____________________________ __________ __________ __________
____________________________ __________ __________ __________
____________________________ __________ __________ __________
TOTAL __________
Verification and Certification
The undersigned officers of Vietnam Veterans of America State Council of ___________________________
certify that we have read the forgoing Service Representative Grant financial report and to the best of our
knowledge and belief certify that the information contained herewith is true correct and complete.
________________________________________ __________________________________________
Name/Title Name/Title
Date: _______________________ Date: _______________________
________________________________________ __________________________________________
Signature Signature
Revised 8/2009