7-Exhibit III - Sample Request for Payment.pdf

This document is an invoice template for a child care facility, prepared for Hillsborough County, Florida, located in Tampa. The template is labeled as Exhibit III and is designed for billing purposes, with line items for two HS (presumably Head Start) Classrooms and training days for teachers and teacher assistants. The invoice is structured to track classroom weeks and training days, with columns for quantity, rate, and amount, though in this example all monetary fields are blank.

The invoice is addressed to Hillsborough County at P.O. Box 1110 in Tampa, FL 33601-1110, and includes placeholders for a specific child care facility's name, address, city, state, zip code, and tax identification number. The document provides a standard format for submitting payment requests, with space for invoice number, invoice date, and the period covered, but no specific financial details are populated in this template version.