Broome County, NY · Broome County
Small Community Fund Payment Request Form
Grantees use this form to request an advance, reimbursement, or final payment from Broome County’s Small Community Fund.
At a glance
- Issued by
- City of Broome County · Broome County, Broome County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- broomecountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets a Small Community Fund grantee request an advance, reimbursement, or final payment under a Broome County grant agreement. It asks for the grantee’s information, grant number, payment request number, expenditure period, expense details, and total amount requested. The form requires backup documentation for submitted expenses and a certification signed by an authorized person.
Who needs it
A Small Community Fund grantee requesting an advance, reimbursement, or final payment for expenses under its Broome County grant agreement needs this form.
How to submit it
Bill the request to the Broome County Department of Planning, 60 Hawley Street, PO Box 1766, Binghamton, New York 13902. The form also says it may be billed electronically to [email protected].
About notarization
This document is signed without a notary; the authorized signer or designee signs and dates the payment certification, and no sworn or notarized attachment is identified.
How to submit this form
- 1
Download the Form
Download the Small Community Fund Payment Request Form.
- 2
Complete the Request
Enter the grantee and grant information, payment request type, expenditure period, expense details, and amount requested.
- 3
Attach Expense Documentation
Attach backup documentation for all submitted expenses.
- 4
Sign and Date
Have an authorized signer or designee certify, sign, and date the request.
- 5
Bill the County
Bill the request to the Broome County Department of Planning at the form’s listed address or email.
Frequently asked questions
- What is the Small Community Fund Payment Request Form for?
- It lets a Small Community Fund grantee request an advance, reimbursement, or final payment and provide details about expenses under its grant agreement.
- What documentation should accompany the request?
- The form asks grantees to attach backup documentation for all submitted expenses. It also requests expense details and the total amount requested.
- Do I need a notary for the Small Community Fund Payment Request Form?
- No. The form has no notary block; an authorized signer or designee signs and dates the certification. It does not identify any sworn or notarized attachment.
- How do I submit the Small Community Fund Payment Request Form?
- Bill it to the Broome County Department of Planning at the address listed on the form, or bill it electronically to [email protected].