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TOBACCO TRUST FUND COMMISSION ' <br />EXHIBIT C, FINANCIAL REQUEST FORM _ _ ___ _ PURPOSE FOR FILING C_H_E_C_K O_N_ E) <br />r ~ ~ ~ ~~REQUEST FOR FUNDS ~~ ~ ~ 1QUARTERLY REPORT <br />Date: <br />Project Number: TTFC Grant Amount: <br />Grant Reci lent: Pa ment Re nest Number: <br />Project Title: Amount This Request: en nn <br />re of Chief Financial Officer <br />A B <br />Itemized Expenditures as Shown in Exhibit A, TTFC Budget as <br />Scope of Services Shown in Scope of <br />Services <br />Totals ~ $0.00 ~ <br />ixv ice: ii any amp <br />Amount Expended <br />List other revenue sources for this project <br />TOTAL 0.00 <br />C D E F G <br />TTFC Amount <br />Previously <br />Re nested <br />9 Amount of TTFC <br />Funds Expended To <br />Date TTFC Amount This <br /> <br />Request Total Requested <br />TTFC Funds <br /> <br />(Columns C plus E) Unrequested TTFC Funds <br />Remaining (Columns B <br /> <br />minus F) <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 ~ 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0:00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br /> 0 0.00 0.00 <br />$0.00 $0.00 $0.00 $0.00 $0.00 <br />uus w cumnm „arc nc acrve, cuniact ine i i r ~. ~mmeu~ace~ . <br />s ,irtta i~bt :~ameA.~~i+~~ to a ~ ~t~ ~r F~,~'(t~fb~ ~~, - y <br />r ~ ~. <br />'h'e~~e ~pC,~'~.~~ ~,, ar+~ .. ~i;q. ~J'.;y, ~~. .''" Syy' aa^~-'`"`a s~ v~ 'i ~~ri~~~~~ ~ <br />,i~~f ~ ~It tl~!~~~ris~it ~~i#~t~je ~' ` ~~ -~~ ~"~ ~ ~-~ ~~-~~ ' ~~~~ 1: <br />Revised 11-2008 <br />