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Report of Services Rendered to the Wyoming Historical Records Advisory Board (SHRAB)
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In Support of NHPRC SNAP Grant # RC-100233-18
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Report Submitted by:
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Name of Individual contributing time:
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Title:
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Agency:
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Address:
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Email:Telephone:
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Services rendered:
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DateActivityNumber of Hours
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Number of Hours reported on additional sheets (see page 2/additional pages) :
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TOTAL NUMBER OF HOURS CONTRIBUTED :
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 @ Wage per Hour: $Total amount (wage X total hrs.) : $
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I certify that the hourse reported above are just and correct, and that they were incurred in connection with my activities or responsibilities on behalf of the Wyoming SHRAB
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Signature:Date reported:
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Approved by: (for Wyoming SHRAB Administrative Use Only)
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Signature:
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Name:
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Title:
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Date:
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Each individual contributing hours, should accurately complete & sign their individual form(s), and attach it with other grant completion documents and mail to: Michael Strom, Wyoming State Archives, Barrett Building, 2301 Central Avenue, Cheyenne, WY 82002
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If necessary, use this sheet and/or additional sheets if necessary, to record additional hours, then attach to cover sheet.
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Date:ActivityNumber of Hours
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