Dema Reimbursement Voucher Template
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1DEMA Reimbursement Voucher
SUBGRANT PROJECTS
1. Agency Name:
2. Project Title:
3. Voucher Number:
______________________
4. Period of Claim:
5. Signature and Phone Number:
6. Date Prepared:
Start:__________ End:____________
_____________________________
_______________________
7. Project Cost
8. Line Item
9. Amount of this
10. Total Line Item
11. Unclaimed
Summary:
Approved
Claim for Line Item:
Expenditures to date:
balance of Line
Totals:
Item to date:
PERSONAL
SERVICES:
CONTRACTUAL
SERVICES:
SUPPLIES &
MATERIALS:
EQUIPMENT:
OTHER:
TOTALS:
**FOR DEMA USE ONLY**:
Funding Source: ____________________
Approved For Payment By: ________________________
Date: ____________________
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Parent category: Life