Department of Neighborhood Empowerment
Board Vote on Funding Request
Budget Fiscal Year:
Meeting Date: Vendor:
Agenda Item: Amount:
Board Member Name Board Position Yes No Abstain *Recused Absent Ineligible
*Recused-Boardmember must leave the room prior to discussion and vote of agenda item.
NEIGHBORHOOD COUNCIL CERTIFICATION
□ One Time Expense
_____ (enter # payments)
We, ____________________________(Treasurer Name) and _________________________(Signer Name), declare that we are the Treasurer and Signer, respectively of the
_______________________ Neighborhood Council (NC) and that on ________________(date adopted), __________________________NC held a public meeting in accordance with
the Brown Act, with a quorum of _____ (number) board members present, and that by a vote of _____ (number) yes, _____ (number) no, and ______(number) abstentions the
_____________________________ NC approved the above indicated Expenditure Request and Authorization Form.
NC Additional Comments