Funding-Request-Form-Sept-2016.xlsx

	A	B	E	F	G	I	J	Q	S	T	U	V	W	Y	Z	AA	AB	AC	AF	AI
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3	Type in your board member's names and save this document as a template for subsequent voting actions.	Department of Neighborhood Empowerment
4		Funding Request Form
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6		NC NAME:	Silver Lake
7		Budget Fiscal Year:			2016							Requestor:
8		Request Date:									Vendor:
9		Meeting Date:									Address:
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11		Agenda Item:									City:						State:
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13											Zip Code:					Phone:
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15											Amount:$
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17											# of payments
18											# of payments
19		If a bank card exemption of the daily $1,000 limit is required for this request, please provide the date(s) and amount needed for the daily limit to be lifted:
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22			Public Benefit
23			Description
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27		Vote Count (Continued on page 2 if more than 20 Board Members) *Recused-Boardmember must leave the room prior to any discussion and may not return to the room until after the vote is completed.
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30		Board Member Name					Board Position	Yes		No			Abstain		*Recused			Absent	Ineligible	If you use the document as a live document at meeting, and as you place the "x" in the cell for the vote, the document will count the "x" at the end of the column and in the section at the bottom.
31	1	Heather Carson					At-Large Rep
32	2	Jerome Courshon					At-Large Rep
33	3	Glenn Harrell					At-Large Rep
34	4	Patty Jausoro					At-Large Rep
35	5	Anne-Marie Johnson					At-Large Rep
36	6	Scott Plante					At-Large Rep
37	7	Antonio Stifano					At-Large Rep
38	8	Jia Gu					Region 1 Rep
39	9	Doug Loewy					Region 1 Rep
40	10	Barbara Ringuette					Region 2 Rep
41	11	Elizabeth Torres					Region 2 Rep
42	12	Adam Somilleda					Region 3 Rep
43	13	Nicolas Somilleda					Region 3 Rep
44	14	Rusty Millar					Region 4 Rep
45	15	Tracey Woolfolk					Region 4 Rep
46	16	Robert Lisauskas					Region 5 Rep
47	17	Caroline Pham					Region 5 Rep
48	18	Betsy Isroelit					Region 6 Rep
49	19	Taryn Poole					Region 6 Rep
50	20	Stacey Boucher					Region 7 Rep
51		NC Quorum: __________________	11				Grand Total (including page 2):	0		0			0		0			0	0
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53		We, the Treasurer and Signer of the above indicated Council, declare that the information presented on this form is accurate and complete, and that a public meeting was held in accordance with the Brown Act, where with a quorum of Board Members present, the Council approved the above action.
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60		Once the Department approves a Funding Request submitted, the Department will transfer the requested amount into the Neighborhood Council's checking account automatically, i.e. no additional Cash Request Form is required.
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62		Treasurer's Signature:							Signer's Signature:											Print this document for Signatures
63		Print/Type name:				Patty Jausoro			Print/Type name:					Terrence Jackson						Print this document for Signatures
64		Date (mm/dd/yy):							Date (mm/dd/yy):
65		Department Use Only
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68		Revised 1-26-15
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71		NC NAME:		Silver Lake
72		Meeting Date:
73		Agenda Item:
74		Vote Count *Recused-Boardmember must leave the room prior to any discussion and may not return to the room until after the vote is completed.
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77		Board Member Name					Board Position	Yes		No			Abstain		*Recused			Absent	Ineligible
78	21	Terrence Jackson					Region 7 Rep
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80	23
81	24
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84	27
85	28
86	29
87	30
88	31
89	32
90	33
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100	43