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Read more about the Community Development Block Grant CV Program invoice instructions

Step 1 of 4 - GENERAL INFORMATION

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  • SECTION I: GENERAL INFORMATION

  • 5. CONTRACT ACTIVITY PERIOD (MONTH, DAY, YEAR):
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • 6. INVOICE REPORTING PERIOD (MONTH, DAY, YEAR):
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
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  • SECTION II: FISCAL INFORMATION

  • If yes, how much?Please select the type 
  • DCED USE ONLY
  • Conditions
     
  • 1. IDIS ACTIVITY NAME (INCLUDING ADMIN)2. IDIS ACTIVITY NUMBER3. IS THIS A MULTI-YEAR PROJECT?4. EXPENDITURES THIS INVOICE PERIOD (DO NOT DEDUCT OTHER INCOME)5. OTHER INCOME TYPE6. GRANTEE USE ONLY (OTHER INCOME USED)ER DATENOT METMETN/A 
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  • SECTION III: INVOICE INFORMATION

  • If you have any other income or multi-year activities, describe them here.
  • If you have any other income or multi-year activities, describe them here.
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  • SECTION IV: CERTIFICATION

  • Pursuant to the Pennsylvania Electronic Transactions Act – Act 69, effective January 15, 2002, you are about to engage in an electronic transaction with the Commonwealth of Pennsylvania. You are submitting official information. You certify under penalty of law that this document and all attachments were prepared under your direction or supervision in accordance with a system designed to assure that qualified personnel gather and evaluate the information submitted. Based on your inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the information submitted is, to the best of your knowledge and belief, true accurate and complete. You are aware that any false statement may be subject to substantial civil and criminal penalties, including 18 P.S. section 4904 (relating to unsworn falsification to authorities).

  • NOTE: The AUTHORIZED SIGNATOR must be an elected official or designated individual other than the contact person listed.

  • Date Format: MM slash DD slash YYYY
  • Any false statements made willfully may be subject to penalties under Section 1001 of Title 18 of the United States Code.

    The initial review performed by DCED on this invoice does not constitute acceptance of its associated expenditures. DCED's Compliance Monitoring Division will conduct a comprehensive review during the contract period to ensure eligibility of all related expenditures.

  • DCED USE ONLY

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.
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