CLAIM FORM 2023-24
Packard Stay & Play Grant #2022-74249
Library:
I hereby request payment as a participant in the Packard Foundation funded Stay & Play project. These funds will be used for expenses, incurred by June 30, 2024, implementing my library jurisdiction's Stay & Play program(s).
Signature Title
Name Date
Payable to:
(If different than above)
Address:
******************************************************************************************************************************** Approved by Paula MacKinnon
Signature Date
EMAIL one scanned, signed copy for review
to: [email protected]
Then MAIL one original signature to:
Califa Group
Attn: Paula MacKinnon
330 Townsend St., Suite 133
San Francisco, CA, 94107
$