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					NFMC MATCH DOCUMENTATION FORM
Electronic Version is Available at www.nw.org/nfmc

National Foreclosure Mitigation Counseling Program NeighborWorks America
INSTRUCTIONS 1. Review the "Example" tab of this Excel Spreadsheet 2. Complete the documentation table below - enter all required information for each item. 3. Sign the certification statement 4. Print and return with your start-up documentation. CERTIFICATION

________________________________________________ (name of Grantee) certifies/confirms that these donations are being used for and in accordance with the Grantee’s Foreclosure Program.

Signature of Executive Director, CFO, or Authorized Official

Date

Name of Exective Director, CFO, or Authorized Official

A

B

C

Date

Entity providing the match

Type of Match Provided Cash In-Kind

D E F G H For In-kind Match resources: state the type and details of inkind resources Where applicable: Quantity provided: (See or Number of Hours of InWhere comment or "In Kind kind resources or services applicable: Required Details" tab (If applicable - if not, leave Hourly Rate / of this Excel blank - do not enter Unit Cost of In- Total value Total Value of workbook for anything or calculations will kind resources of in-kind Match examples) not work) or services contribution Provided $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL IN-KIND MATCH DOCUMENTED $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

NFMC MATCH DOCUMENTATION FORM
Electronic Version is Available at www.nw.org/nfmc

National Foreclosure Mitigation Counseling Program NeighborWorks America EXAMPLE NFMC MATCH DOCUMENTATION TABLE

A

B

C

Date 11/11/08

Entity providing the match United Bank

Type of Match Provided Cash In-Kind $50,000.00

D E F For In-kind Match resources; state the Where applicable: Quantity Where type and details of inor Number of Hours of Inapplicable: kind resources kind resources or services Hourly Rate / provided: (See (If applicable - if not, leave Unit Cost of Incomment for blank - do not enter anything kind resources examples) or calculations will not work) or services

G

H

Total value Total Value of of in-kind Match contribution Provided $0.00 $50,000.00

11/15/08

The Foundations

11/15/08

The Legal Group

11/1/08

National Foundation

Speaker for UTC group foreclosure meeting to be held on the 28th of Facilitation of a November at The $0.00 Foreclosure meeting Hilton, Washington DC 3 mid-level legal counselors to provide $10,000.00 Provision of Staff time legal counseling Provision of 3 meeting rooms for 4 hours on a weekly basis for NFMC counseling for the 12 Provision of Meeting weeks (12*3*4 = 144 $0.00 Rooms hours) Office space for 1 employee @ $10/square foot x 50 square feet x 3 months Printing of 1000 Fliers for the Foreclosure Networking Program Provision of 3 HP Color LaserJet CP2020 Printer series .

2

20.00

$40.00

$40.00

240

150.00

$36,000.00

$46,000.00

144

100.00

$14,400.00

$14,400.00

Sept - Nov 2008

The Realtors

$0.00 Cost of Office Space

150

10.00

$1,500.00

$1,500.00

11/1/08

Office Depot

$0.00 Printing of fliers

1000

20.00

$20,000.00

$20,000.00

11/15/08

Office Depot

$0.00 Provision of Printer $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$1,326.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL IN-KIND MATCH DOCUMENTED

3

442.00

$1,326.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $133,266.00

NFMC PROGRAM: Examples of the required details for in-kind resources are 1. Office Equipment and Supplies: Type, name and details of equipment or supplies. (i.e. printers, duplication machines, Printing paper, office stationary) 2. Office Space: Location of Office, details of the Office measurement(i.e. in square feet). 3. Volunteer / Staff time: Staff level, Designations of staff and volunteer personnel.

4. Provision of Corporate services and Facilities: (financial and administrative support services, meeting space, mailing services and computer services: Please provide the description of the type of services, the number of times and duration over which these services will be provided.

5. Provision of Professional services such as training services; graphic arts/design services; advertising/promotion/marketing; legal assistance; tax, business and financial advice. Please provide the description of the type of services to be provided, the number of hours and duration over which these services will be provided. Signed Contracts with professional service firms, if any.


				
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