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• <br /> TOBACCO TRUST FUND COMMISSION <br /> EXHIBIT C: FINANCIAL REQUEST FORM PURPOSE FOR FILINGLCHECK ONE) <br /> (REQUEST FOR FUNDS I (QUARTERLY REPORT <br /> Date: <br /> Pro ect Number:2008-041-22 TTFC Grant Amount: $ 479,000.00 <br /> Grant Red,lent:Oran_e Coun North Carolina Payment Request Number: . <br /> Protect Title:Piedmont Value-Added Shared-Use Food& Amount This Request: $ - <br /> Agricultural Processing Center <br /> Signature of Chief Financial Officer: <br /> CO <br /> 0 <br /> C) A B C D E F G <br /> C) <br /> K TTFC Budget as TTFC Amount Amount of TTFC Total Requested Unrequested TTFC Funds <br /> CD Itemized Expenditures as Shown in Exhibit A, TTFC Amount This <br /> tD Shown in Scope of Previously Funds Expended To TTFC Funds Remaining(Columns B <br /> Scope of Services Services Requested Date Request (Columns C plus E) minus F) <br /> L E'ui.mentAc'uisition and Installation $ 357 000.00 0 0.00 357,000.00 <br /> SD Executive Director Sala &Benefits Full-Time $ 60 000.00 0 0.00 60,000.00 <br /> m <br /> C Le:: Accountin: :Id ' 1 • .01% •u • $ 2 300.00 0 0.00 2,300.00 <br /> !v Office Su.'lies $ 1 500.00 0 0.00 1,500.00 <br /> N Cleanin:Su..lies&Waste Mana: ment $ 4 000.00 0 0.00 4,000.00 <br /> N Marketin: $ 5 000.00 0 0.00 5,000.00 <br /> N E.u'. 'ent Maintenance 'arts and Labor $ 10 000.00 0 0.00 10,000.00 <br /> o Staff Travel $ 1000.00 0 0.00 1,000.00 <br /> 0 Insurance $ 4 000.00 0 0.00 4,000.00 <br /> Buildin:Maintenance&Utilities $ 34 200.00 0 0.00 34 200.00 <br /> CD <br /> Ca <br /> CD Totals '000.00 $0.00 $0.00 $0.00 $0.00 $479,000.00 <br /> W NOTE:If any amounts in column G are ne.ative contact the TTFC immediate) . <br /> Amount Expended r Ifa �g ai'4 R' eh 31 d s <br /> I <br /> • List other revenue sources for this project j <br /> 0.00 <br /> TOTAL ,a4 � .. � �, _._... <br /> Revised 11-2008 W <br />