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CITY OF CENTERVILLE <br />REVOLVING LOAN AND GRANT PROGRAM <br />GRANT REIMBURSEMENT REQUEST <br /> <br />Business Owner(s): <br />Business Name: <br />Business Address: <br />Phone: <br />Qualifying project work complete (this request): <br />Cost of work (this request): <br />Grant amount requested (this request): <br />Total project cost to date (including this request): <br />Total grant reimbursed (including this request): <br />I hereby acknowledge that the facade work and/or materials referenced above have <br />been completed and paid for at the above address, and documentation for that work <br />is attached. <br />_____________________________________________ _______________ <br />Signature of Owner Date <br /> <br />_____________________________________________ ______________ <br />Signature of Executive Director EDA, Date <br />Authorizing Reimbursement <br />16 <br /> <br />