The document is a form for a neighborhood council board vote on a funding request. The form includes spaces to record the neighborhood council name, fiscal year, meeting date, vendor, agenda item, amount, recurrence, and individual board member votes (yes, no, abstain, recused, absent, ineligible). It also includes a certification section for the treasurer and another signer to declare the funding request was approved by the neighborhood council in accordance with the Brown Act.

1. Department of Neighborhood Empowerment
Board Vote on Funding Request
NC NAME:
Budget Fiscal Year:
Meeting Date: Vendor:
Agenda Item: Amount:
Recurrence:
Board Member Name Board Position Yes No Abstain *Recused Absent Ineligible
TOTALS
Treasurer Signature
Print Name
Date
Vote Count
*Recused-Boardmember must leave the room prior to discussion and vote of agenda item.
NEIGHBORHOOD COUNCIL CERTIFICATION
Description:
□ One Time Expense
□ Monthly
□ Multiple
_____ (enter # payments)
We, ____________________________(Treasurer Name) and _________________________(Signer Name), declare that we are the Treasurer and Signer, respectively of the
_______________________ Neighborhood Council (NC) and that on ________________(date adopted), __________________________NC held a public meeting in accordance with
the Brown Act, with a quorum of _____ (number) board members present, and that by a vote of _____ (number) yes, _____ (number) no, and ______(number) abstentions the
_____________________________ NC approved the above indicated Expenditure Request and Authorization Form.
Date
NC Additional Comments
Signer's Signature
Print Name