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CITY OF CARLSBAD
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LODGERS TAX GRANT REIMBURSEMENT REQUEST
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GranteeDate
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Grantee Address
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Contact Person
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Phone
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E-mail
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Approved Grant Amount $ -
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Event Dates
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Please list Advertising Expenses such as Newspaper, Radio, Television, Magazines, Cost of Poster/Flyers, Postage, and Mailings Below.
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100%
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NamePurposeInvoice #AmountReimbursement
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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 $ - $ -
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Total Reimbursement Requested $ -
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Signature & Title
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Audited and approved by
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(City of Carlsbad Finance Officer)
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City Administrator signature
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Instructions:
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Grantee: Enter the organization name.
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Grantee Address: Enter the address including City, State, and Zip to where reimbursement checks should be mailed.
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Contact Person: Enter the name of the person to contract if there are questions about the reimbursement request.
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Phone: Enter the telephone number of the Contact Person.
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E-mail: Enter the e-mail address of the Contact Person (this is optional)
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Approved Grant Amount: Enter the dollar amount approved by the Lodgers' Tax Board.
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Event Dates: Enter the date/dates of the event (mm/dd/yy or mm/dd/yy,mm/dd/yy, mm/dd/yy or mm/dd/yy-mm/dd/yy)
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Date: Enter the date of the Reimbursement request.
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List each vendor, the purpose (print flyers, mail flyers, radio ads 6/1/13-6/30/13, full page add in magazine), the invoice #, and amount of invoice.
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The Reimbursement amount will automatically calculate based upon the percentage listed above "Reimbursement".
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The Total Reimbursement Requested will automatically calculate.
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Please note that to be reimbursed a copy of each invoice and proof of payment (cancelled check or bank draft) must be presented with Reimbursement Request Form.
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If the Grant is limited to 50% Reimbursement, change the 100% that is above "Reimbursment" to 50% for the Reimbursement to calculate correctly.
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