HomeMy WebLinkAboutGrant Related - BOCC (002)GRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: BOCC
REQUEST SUBMITTED BY.. Karrie Stockton
CONTACT PERSON ATTENDING ROUNDTABLE: KaC'f'I@ Stockton
CONFIDENTIAL INFORMATION: DYES ANO
DATE:2/26/2024
PHONE:F'Xt. 2937
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Reimbursement Request from New Hope on the Consolidated Homeless Grant (CHG) in
the amount of $1,235.00.
DATE OF ACTION: E5
APPROVE: DENIED ABSTAIN
D1:
D2:
D3:
DEFERRED OR CONTINUED TO:
'. ... .. - 1:'
Li t
1., Grantee_Name
s Sub`Grantee Names
M nth Year_
Invo ce o _ , .
New Hope Jan -24
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Total $1,235.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Invoice Total: $1,235.00
Signature
County of Grant
35 C STNW
P.O. Box 37
Ephrata WA 98823
Vendor: HERON CREEK APARTMENTS
222 EAST 9TH AVE
MOSES LAKE WA 98837
Document Number
Description:
CLIENT EFA - RENT
. . . . . . . .............. ......
purerI
o Order Number VendorlD
------------- --
Page 1/1
Invoice 0405580
Date 1/9/2024
... . .......... .......od ......... . . .
Shipping MethPayment Terms ID
------------
HERONrrr.�.r-ii.-awiiaiiro. i.iii.v.ar.r. ..rer.... iarruA ...r...
Amount
$1,235.00
Subtotal
$1,235,00
Misc
$0.00
Tax
$0.00
Freight
$0.00
Trade Discount
$0-00
Payment
$0.00
Total Due
$1,235.00
CHG Voucher Detail Month January 1-31, 2024
Vendor Code Descriptio Amount charged to the grant
Heron Creek 565504580 Rent 1235
Total 1235
i A-1
qW,
new Vis: belfterr tomorrows,
OffiC
lient:
l./ S A 1ICV 0 CArl!
I
d iT!M =F-AV9
* Background check for housing
# Children's needs
# Debt assistance
* Driver's license
* Education training
# Bus fare to return home
# Cell phone to seek work/housing
# Family well being
Housing Authority
0 Salvation Army
0 Serve ML/Quincy
DSHS
4 CPS
0 Family contribution
0 Friend contribution
Date Submitted: 1/8/24
#
4 of Children,
Client's Home City- Moses Lake
0 � t
- W-. no mts I
Has called housing and hope source and not able t
get assistance.
PGRAM ODSHS;4HG OSA DCV -OCAC giL
METHOD OF PAYMENT: CoU6 ty Voucher .[]Petty Cash ECredit Card
lhdlU'deba*ck'q'p documentaUon'.* (Rece-ipt of Ch e
Copy ck, 1 -9 if Appli 'ble)
Ga
Updated: 08/31/2023
Client was working and her slo kept calling on purpose t
* Mortgage
* Service DVPO
get her fires and she was let go. She did find new
* Utilities bills
employment but got behind on her rent andis needing
* Security Assist
help..
* Rental Assist
* Car payments
* Food/Necessities
Has called housing and hope source and not able t
get assistance.
PGRAM ODSHS;4HG OSA DCV -OCAC giL
METHOD OF PAYMENT: CoU6 ty Voucher .[]Petty Cash ECredit Card
lhdlU'deba*ck'q'p documentaUon'.* (Rece-ipt of Ch e
Copy ck, 1 -9 if Appli 'ble)
Ga
Updated: 08/31/2023
GRANT COUNTY
New Hope/Kids Hope Kids Hope
new
PROMISE T O PAY
�Date 1/8/2024
Vendor: HERON CREEK APARTMENTS, LLC
Post officeAddress: 222 E 9TH AVE MOSES LAKE, WA 98837
Total Amount $1235-00
All bills must be itemized in detail on this blank or itemized list attached herewith. When submitting clainis for
-
rent be sure to speciFy dates claim is intended to cover.
ISSUED:
For Submission for Payment -
Return Voucher To. -
BECKY GARCIA Grant County
New Hope/Kids Hope
New Hope/Kids Hope Advocate 311 W Third Avenue Moses Lake,
WA 98837
1 hereby Certify on Honor, that the goods, merchandise, material or service charged for in the above bill have been
furnished as herein charged.
DATE: 1/8/2024
. Wwwj;i
r7 rYA%
C
A T
A 1H
Printed Vendor Name
I
Signature
CANNOTBE USED FOR ALCOHOL, TOBACCO, Check one: Mail payment to above address
PR' -PAID OR G117 CARDS, E] Claimant will pickup. merit at
-pay
N e LN�o e
Vouchers received by 12,00 pm Wednesday will have payment available the following Thursday.
EMERGENCY FINANCIAL ASSISTANCE FORM
SIGNED? YES 21 NO[]
FUNDING: 7611
Resident Unpaid Charges (NON HAP)
FP1 MANAGEMENT
Date: 01105/2024
Code ----------
t0898178
...
..P-r,o-pe tv---
10/0612022
Lease From
ame
Address
222 EAST 9TH AVE 4100
Unit
Status
— ------------ Current
-----------
Lease To
Move In
09/30/2023
10/06/2022
Rent 1235.00
Move Out
[city
MOSES LAKE, WA 98837
JPhone
Phone (W)
1(425) 382-0536
Date
Chg Code Post Month
-------- —
Description
Vacant
cha.rge Payment Balan'ce hg/Rec
12/01/2023
utl'lwla 12/2023
Electric - 09/14/23-10/03/23
Vacant Service Fee - 09/14/23-10/03/2-3
38.16
38.16 M-864504
.12/01/2023
Utilwla 12/2023
— 50
01/01/2024
rent 01/2024
MONTHLY REN -T (01/2024),
,00
88.16 �L886450S
1.1235,00
1*323. 92 " 5 3
01/01/2024
uta ilwi 0112 o24
Vacant Electric -14/43/23-10/17/23
24.56
.16
14347.72 49458-5=07
01/01/2024
�—[
Vacant S—erviceFee- 1003/3 -10/17
501M
11397,72 - 49-458508
U� JoBI��!
j
ForrnWWX9
(Rev. October 2018)
'Ie,a"Me to" a Treasurl
Internal Cmn2o Service
L�
CL
0 C
0
0
CO
N&me(as s-hovin- ------ on —youf
trf--ftwohw.'�li
2 Efusiness nam -'e/
Request for Taxpayer
Identification Number and Certification
irs
)b.-. GO to MAIM' -90v1F0rMW9 for Instructions and the latest nfortnation,
I
tax return). [Name is required an this line, do
Ii��i_tFls line blank.
J e J t ,
3 Check appropriate be for federal tax class*
following seven boxes. Ification of the Pearson whose name is entered on line 1. Check only one of the
El Individual sole proprietor or El 0 Corporation El S Corporation El Partnership Trust/eetate
single -member LLC
M*1ted liab!14 company. Enter the tax classificatiDn (C=C corporation, S=S corporation, P=Partne rahip) 0.
Note- Check the appropriate box In the line above for the tax classification of the single -member owner. Do not check
LLC If the LLC Is classified as a single -member LLG that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax. purposes, Otherwise, a sinole-member LLC that
Is disregarded from the owner should check the appropriate box for ths tax Classification of its owner_
Other(see Instruct!
Jress (number, street, and apt. or suite no.) See instructions.
6
ity, sta�
an-d_ii�
"t code
C-fev
7 List account number(s) here (q�flonal)
Give Form to the
requester. Do not
send to the IRS*
4 Exemptions (codes apply only to
certain entities, not Individuals, see
instructions on page 3). -
Exempt payee code If any)
ExemPtlOn from FATCA reporting
code Of any)
requester's name and address (optionA
M -MR -1 f KIN M MCULlitc;ation riumner (VIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For Individuals, this Is generally your social security number (SSN), However, I for a
resident alien, sole proprietor, or disregarded entity, see the Instructions for Part 1, later. For other
entities, It Is your employer Identification number (EIN). If you do not have a number, see How to get a
TIN, later,
Social security number
or
1. The number shown on this form Is my correct taxpayer identification number or I am waiting for a number to be Issued to me and
2. 1 am not subject to backup withholding because:(a) I am exempt, from backup Withholding, or (b) I have n&t been no by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, Pr (c)the IRS has notMed me that I a
no longer subject to backup withholding, and m
S. I am a U.S. citizen or other U,S. person (defined below); and
4. The FATCA coda(s) entered on this form (if any) indicating that I am exempt from FAT A. reporting Is correct.
Certification instructions. YOU must cross out Item 2 above if you have been notified by the IRS that you are currently subject, to backup withholding because
you have Wiled to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply, For mortgage Interest paid,
'icquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not�0to sign the certification, but you must provide your correct TIN. See the instructions for Part 11., later.
A 1:e
sign I Signature of
Here U.S. person *
General Instructions 41
Section references are to the Internal Revenue Code unless otherwise
noted..
Future developments. For the latest Information about developments
related to Form W-9 and Its instructions, such as legislation enacted
after they were published, goto wvNv.Irs.v1Fcg0;rmVV9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
Information return with the IRS must obtain your correct taxpayer
Identification number ("IN) which may be your social security number
(SSN), individual taxpayer identification number (ITIS), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an Information return. Examples of information
returns include, but are not limited to, the following.
* Form 1099 -INT (Interest earned or paid)
Date 10 -
Form 1099 -DIV (dividends, including those from stocks of mutual
finds}
* Form 1999- II (various types of income, prizes, awards, or gross
proceeds)
* Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
# Form 1099-8 (proceeds from real estate transactions)
* Form 1099-K (merchant card and third party network transactions)
# Form 1098 (home mortgage 'Interest), 1098-E (student loan interest),
1098-T (tuition)
t Form 1099-C (canceled debt)
Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What Is backup withholding,
la ter.
Cat. No. 10231X
Form W-9 (Rev, 10-2018)