2014/2015 Acquittal Form
Community Grants
 It is recommended that you refer to your copy of the original application sent to Council to assist
you in completing this form.
 You must include photos (in .tiff or .jpg format) of the event and a copy of all receipts.
 Where auspiced, you must include a letter from the auspicing organisation confirming the grant has
been fully expended.
 Electronic copies of this form are available at www.mitchellshire.vic.gov.au
 Completed acquittals are to be submitted to Council by 15 May 2015
1. Grant Details
Grant Year
Grant amount
2014/2015
Project Name
Grant Category
Artistic and Cultural Activities
Community Celebrations
Community Development and Wellbeing
2. Recipient Details
Organisation’s Name
Contact Person’s Name
Business hours no.
Mobile no.
Email
3. Declaration



To the best of my knowledge I declare that the information in this report
is true and correct.
The financial accounts are true and fair, and a statement of the balance of
the grant funding. The grant funding was expended on the
project/activity in accordance with the Grant Funding Agreement signed
with the Mitchell Shire Council and as per the original Grant Application.
I have returned any unspent grant monies to Council with this report.
I agree to the above declaration
Name
Position in organisation
Date
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4. Project Summary
Please answer all the following questions for this acquittal report to be
deemed complete. Please also attach materials developed as part of this
project e.g. media coverage, flyers, photos in either .pdf or .tiff or .jpeg
format.
1. Please briefly describe your project and its outcomes. What did you
do? How did the community benefit? Who was involved? (Maximum 400
words)
2. How many people participated in your project?
No of males:
No. of children:
No of females:
No of people of all abilities:
How did the project encourage participation from a wide range of
people (People from culturally and linguistically diverse backgrounds,
Youth, Seniors, people of all abilities)? (Maximum 200 words)
3. How many volunteers and partnering organisations worked on your
project and in what capacity? (Maximum 100 words)
4. Was the project successful in the way you expected? If not, how did it
differ? What would you do differently next time? (Maximum 300 words)
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5. Statement of
Income and
Expenditure
Please include a copy of all receipts.
Please note unspent grant funds must be returned to Council with this
report.
Actual Income
Income source
Amount
Actual Expenditure
Items purchased with the Mitchell
Community Grant
Cost
Mitchell Community Grant (a)
Organisation’s own money
contribution
Give details
In-kind contribution including
volunteer staff (to be costed at $25
per hour)
Give Details
Project generated income
Give details of sales, tickets etc
Total (b)
Items purchased with other funding
sources
Cost
Other grants, sponsorship or
donations
Give details of state, federal or
private funding received
Any other income
Give details
Total
Total
Mitchell Community Grant amount (a)
Items purchased using Mitchell Community Grant (b)
Total (a) – (b) = surplus or (deficit)
Completed acquittals and attachments are to be submitted by email to:
[email protected]
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