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CASH <br />MATCHING SHARE <br />Donor: <br />Source: <br />Total Cash Amount: $ <br />IN-KIND SERVICES <br />Donor: <br />Source: <br />Total In -Kind Services Amount: $ <br />VOLUNTEER SERVICES <br />Donor: <br />Source: <br />Total Volunteer Services Amount: $ <br />TOTAL MATCHING SHARE: $ <br />Nate: This amount should equal that given on Line 7-c of the Proposal Cover Sheet. <br />CERTIFICATION OF MATCHING SHARE <br />I certify that the matching share funds/goods/services identified above are available, and that they will be allocated <br />only to the Historic Preservation Fund project described in this application and titled: <br />Project Title <br />Name and Title of Authorized Representative <br />Signature Date <br />Applicants are strongly encouraged to submit appropriate documentation of the matching share (copies of bank <br />statements, etc.) following this form. Please note that proposals submitted without documentation WILL NOT <br />receive full credit for the matching share under the Administrative Priorities. <br />18 <br />