Form VTPC-05 "Quarterly Reimbursement Request" - Maryland

What Is Form VTPC-05?

This is a legal form that was released by the Maryland State Police - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Maryland State Police;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form VTPC-05 by clicking the link below or browse more documents and templates provided by the Maryland State Police.

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Download Form VTPC-05 "Quarterly Reimbursement Request" - Maryland

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STATE OF MARYLAND
VEHICLE THEFT PREVENTION COUNCIL
Grant Award Number
QUARTERLY REIMBURSEMENT REQUEST
TITLE OF PROJECT:
GRANTEE:
REPORT QUARTER ENDING:
9/30
12/31
3/31
6/30
Amount of Award
$
Requested to Date
$
Amount Available to be Drawn
$
Amount of Request
$
(
Attach Quarterly Financial Report
for Budget Detail Expenditures)
Balance
$
(after receipt of Request)
PAYMENT TO: (This Section must be completed by Grantee in order to receive payment)
Federal Identification Number:
Authorized Payee:
Mailing Address:
I CERTIFY That to the best of my knowledge, information and belief the amounts reported
above are correct and accurate, that all expenditures will be made in accordance with grant
conditions and that payment is due and has not been previously requested.
Fiscal Officer or Project Director
Date Request Submitted
Approved by Executive Director/Deputy Director of VTPC
Date of Approval
Form VTPC-05
Reset
Save
Print
STATE OF MARYLAND
VEHICLE THEFT PREVENTION COUNCIL
Grant Award Number
QUARTERLY REIMBURSEMENT REQUEST
TITLE OF PROJECT:
GRANTEE:
REPORT QUARTER ENDING:
9/30
12/31
3/31
6/30
Amount of Award
$
Requested to Date
$
Amount Available to be Drawn
$
Amount of Request
$
(
Attach Quarterly Financial Report
for Budget Detail Expenditures)
Balance
$
(after receipt of Request)
PAYMENT TO: (This Section must be completed by Grantee in order to receive payment)
Federal Identification Number:
Authorized Payee:
Mailing Address:
I CERTIFY That to the best of my knowledge, information and belief the amounts reported
above are correct and accurate, that all expenditures will be made in accordance with grant
conditions and that payment is due and has not been previously requested.
Fiscal Officer or Project Director
Date Request Submitted
Approved by Executive Director/Deputy Director of VTPC
Date of Approval
Form VTPC-05