This is the Annual Connecticard Expenditure Report Form to be filled out before November 2015. Grant Expenditures may be used for general library purposes. No portion of the CCard payment shall revert to the general fund of the town.

Your library should have received a Connecticard payment in April of 2014 for participation in the Connecticard program from March 2013 to February 2014. Please indicate below how this money was expended.

2. This form completed by:

3. Purpose (enter numbers only, no dollar signs, commas or spaces)

PLEASE NOTE: the amounts listed above MUST total the amount of the grant award listed next to your library's name in question #1.

4. If you entered an amount in "Other" above, please specify here

Please click on the "Submit figures" button below.