Sample Invoice Cover Letter Template

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(Re-create and Print on Agency’s Official Letterhead)
Please replace or remove all non-essential red text prior to invoice submission
California Department of Public Health
Maternal, Child and Adolescent Health (MCAH)
Attn:
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1615 Capitol Avenue, MS Code 8305
P.O. Box 997420
Sacramento, CA 95899-7420
RE: Invoice Submittal for MCAH
(Insert Program
Name) Agreement
(Insert
Number)
Enclosed for payment is our Fiscal Year (FY) _________ (1,2,3,4)
identify applicable
quarter number) (Quarterly and/if
Supplemental) invoice in the total amount of
$________________,
which
covers
the
period
of
______________
through
______________ (inclusive dates) for services rendered pursuant to the terms and
conditions established in the above referenced Grant Agreement.
Note: if reimbursement is being requested for costs not identified in the current
approved budget, please provide additional clarification in this section. If submitting I&E
invoice, please attach time study summary sheets for each staff claiming Federal
Financial Participation.
Sincerely,
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Person Authorized to Sign Cover Letter
Title

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