02/13/2002 Match Commitment
IV .B. MATCH COMMITMENT OF CASH DONATION
Agency Name:
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Monroe County Board of Countv Commissioners/Monroe County In
Home Services Program
Donor Identification:
Name: Monroe County Board of County Commissioners
Street: GATO Building - 1100 Simonton Street
City: Key West
State: FL
Zip: 33040
Phone: 305-292-4572
Authorized Representative: Charles McCoy
Mayor
Monroe County Board of County Commissione s
Total Amount
$ ,14.1..00.0.00
# Payments
1 ?
Amount/Payment
$ Pro :Rated
Contribution Period
7/1/02 thru 6/30/03
Special Conditions:
Donor Certification:
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 0 ract and is not borne by
the federal government directly under any federal grant co ract.
Signature of Donor or Representative:
Date: .:L/ /3 /0;). Mayor
I I
Charles McCoy
January 2002