12/19/2001 Match Commitment
I
IV.B. M' -"CH COMMITMENT OF CASH Di.. ATION
ency Name:
MONROE COUNTY IN HOME SERVICES PROGRAM
Donor Identification:
. , .
Name:
Street:
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
GATO BUILDING
1100 SIMONTON STREET
KEY WEST
FL
33040
305-292-4572
Authorized Representative:
City:
State:
Zip:
Phone:
CHARLES MC COY, MAYOR
Special Conditions:
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Donor Certification:
: hereby certify intent to maIce the cash donation set forth above for USe in the specified program during
he program's upcoming funding period. This cash is not included as match for any other State or
'ederally' rogrant or contract and is nOt borne by the federal government directly under any
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Date: 1.2/I'i/ol
. #
IV.B. MATCH COMMITMENT OF CASH DONATION
Agency Name:
MONROE COUNTY IN HOME SERVICES PROGRAM
Donor Identification:
Name:
Street:
MONROE COUNTY
GATO BUILDING
1100 SIMONTON
KEY WEST
FL
BOARD OF COUNTY COMMISSIONERS
STREET
City:
State:
Zip:
Phone:
33040
305-292-4572
Authorized Representative:
CHARLES MC COY, MAYOR
Total Amount
$ 7,026.00
# Payments
12
Amount/Payment
$ PRO RATED
Contribution Period
1/1/02 THRU 12/31/02
Special Conditions:
Donor Certification:
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I hereby certify intent to make the cash donation set forth above for use in the specified program
during the program's upcoming funding period. This cash is not included as match for any other
State or Federally assisted program or contract and is not borne by the federal government
directly under any federal grant or contract.
Ch{{.,y/es l~nl1J "11CC1'
.~ or Chair/i1tU1 Date:/:A-/9-D/
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Signaturel ~~t Qr'Representative:
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V.B. MATCH COMMITMENT FOR DONATION OF BUILDING SPACE
Agency Name:
Donor Identification:
Name:
Street:
City:
State:
Zip:
Phone:
Authorized Representative:
Description of Space: [] Office [ ] Site
[ ] Other
Provider Owned Space:
1.
Number of square footage used by project:
_sq/ft
3.
Total value of space used by project (1x2):
$
$
2.
Appraised rental value per square foot:
Donor Owned Space:
1. Established monthly rental value: $
.
2. Number of months rent to be paid by donor: mos.
3. Value of donated space (1x2): $
Special Conditions:
Donor Certification:
I hereby certify intent to donate use of the space set forth above for the program specified above
during the program's upcoming funding period. This space is not being used as match for any
other State or Federal program or contract.
Signature of Donor or Representative:
Date:
, '.,.
April 2001
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IV.B. MA ~H COl\1MITMENT OF CASH D(. iTION
ency Name:
MONROE COUNTY IN HOME SERVICES PROGRAM
Donor Identification:
. , .
Name: MONROE COUNTY BOARD 0
F COUNTY COMMISSIONERS
Street: GATO BUILDING
;100 SIMONTON STREET
City. ::
KEY WEST
State: FL
Zip: 33040
Phone: .3(1)-?97.-4572
Authorized Representative: Mr
CHARLES
rnv
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MAYOR
ToW. Amount
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$ <}f:: .47Q '?'j
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# Payments
12
f\. lnt/Payment
$ p~n P'7\TED
Contribution Period
7/1/01 ~~RD h/10/0?
Special Conditions:
Donor Certification:
: hereby certify intent to make the cash donation set forth above for use in the specified program during
he progr~ I S upcoming funding period. This cash is not included as match for any other State or
~~derally assisted program or contract anv;. at borne by the federal government directly under any
'ederal grant or contract. " (J "/I, /'
. {!ha. r /es Jon/Iv ;"!CCoy
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e'tl? /J7aymjcmirman Date: It(-j<;-Ol
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IV.B. MA ~H COMMITMENT OF CASH DC. i.TION
ency Name:
MONROE COUNTY IN HOME SERVICES PROGRAM
Donor Identification:
. . .
Name:
Street:
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
GATO BUILDING
1100 SIMONTON STREET
KEY WEST
FL
33040
305-292-4572
Authorized Representative:
City:
State:
Zip:
Phone:
CHARLES Me COY, MAYOR
Total Amount
$ 594. 8.a
# Payments
12
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.t\ .1ntlPayment
$ PRO lUTFD
Contribution Period
7/1/"1 THRU 6/30/02
Special Conditions:
Donor Certification:
: hereby certify intent to make the cash donation set forth above for use in the specified program during
he pro~ I s upcoming funding period. This cash is not included as match for any other State or
~~deraIIy assisted pro gram or contract and is not bome~e federal government directly under any
:ederal grant or contract. If n
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iignature 0 V A10.y0lchz/'I17(U1Da~: IS-I'l.-D I
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DEPUTY CLERK