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									                                   TOURISM MARKETING INCENTIVE PROGRAM
                                  Reimbursement Request – Second Cycle (January-June)
                                                   FY 2011-2012

Director’s Signature _______________________________ Federal Identification Number (Required)___________________________


Applicant       _________________________________________________________________________________________
Director Name _________________________________________________________________________________________
Address         _________________________________________________________________________________________
                _________________________________________________________________________________________
City ___________________________      State Kentucky        Zip _________________     County _________________
Telephone Number _________________________ E-Mail Address ______________________________________________

Tourism Region:
 Western Lakes & Rivers Region         Louisville Lincoln Region        Bluegrass Region
 Green River Region                    Southern KY Vacations            Eastern Highlands North Region
 Cave Region                           Northern Kentucky Region         Eastern Highlands South Region

Cost of All Projects Listed: $_____________________________________________________

Tourism Marketing Incentive Funds Request $______________________________________




 Date Received:_________________            -- Do Not Write in This Section--


Co-op Percentages:
 (Region) 100% x $__________________________________________ = $__________________________________________________
 (CVB)      90% x $__________________________________________ = $__________________________________________________
 (Attraction/Festivals) 70% x $_______________________________ = $__________________________________________________
 Official Vacation Guide 100% $______________________________
Non Co-op Percentages:
 (Region) 80% x $___________________________________________ = $__________________________________________________
 (CVB/Attraction & Festivals) 50% x $_________________________ = $_________________________________________________
 Convention Bid Fee for Room Nights 80% x $__________________ = $_________________________________________________
 New Event Bid Fee/Sponsorship 70% x $ ______________________ = $_________________________________________________


 Amount Reimbursed $___________________________________         Contract Number PON_________________________
 Agency Number ________________________________________         Vendor Number _______________________________
 Program Manager’s Signature ____________________________       Payment _____________________________________
                              Adjustment(s) made to originally submitted amount(s) due to:
     ___________________________________________________________________________________________________________

								
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