Supplemental Nutrition Assistance Program 
      (SNAP) Community Partnership                    
      CONTRACTOR INVOICE - FFY2018
      Agency Name
      DES Contract ID Number
      Service Month and Year (mm/yyyy)
      Invoice Type (“original” or “supplemental”)
      Invoice Prepared By (name and title)
      Preparer’s Contact Information (phone and email)
      Date Invoice Prepared (mm/dd/yyyy)
                           INVOICE
      SNAP Community Partner           Partner Total Expenses 
      Subtotal (this page)         $                                                 -   
                          Page 1 of 3
                                                        Balance Forward    $                                                               -   
             SNAP Community Partner                                               Partner Total Expenses 
             Subtotal (this page)                                         $                                                 -   
                                                        Page 2 of 3
                                                        Balance Forward    $                                                               -   
             SNAP Community Partner                                               Partner Total Expenses 
             Partner Total Expenses (all pages)                              $                                              -   
             Amount Payable (46% of Partner Total Expenses)                  $                                              -   
                                                                            (round all values to the nearest cent)
             Comments
             Use the space below to enter comments about the expenses on this invoice, as needed.
                                                        Page 3 of 3
                             Email this invoice to: CoordinatedHungerReliefProgram@azdes.gov