HomeMy WebLinkAbout1 - Original Submission_ Template Lodging tax fund reimbursement form (9)CITY OF BREMERTON
LODGING TAX FUND REIMBURSEMENT REQUEST FORM
Date
Contract No.
Total Award Amount
Organization Name
Mailing address
Contact Name:Phone:
email:
Date of Service
Event/Program Title
Total Request:
Tourism Funding Recipient Name (printed):
Tourism Funding Recipient Signature:
Date:
Please return form along with copies of supporting invoices and receipts to:
City of Bremerton
Contracts Administrator
346 6th Street, Ste 100
Bremerton, WA 98337‐1873 Form B.3 2019
Please list your expenses below, attach copies of matching receipts.
If more space is needed please use page 2 of this form.
*I certify under penalty of perjury, the information contained in this request for reimbursement is true and
correct: I am authorized to certify and submit this request; and I am requesting reimbursement of money I
actually spend for the project or event as described in the application and contract with the City of Bremerton.
Page 1
EXHIBIT B
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DocuSign Envelope ID: FB8927B5-6D51-42ED-819A-E535EEC3AE4D
CITY OF BREMERTON
LODING TAX FUND REIMBURSEMENT REQUEST FORM
Date
Contract No.
Organization Name
Please list your expenses below, attach copies of matching receipts.
Form B.3 2019
Page 2
DocuSign Envelope ID: FB8927B5-6D51-42ED-819A-E535EEC3AE4D