New Jersey Administrative Code
Title 2 - AGRICULTURE
Chapter 71 - GRADES AND STANDARDS
Subchapter 4 - JERSEY FRESH MATCHED FUNDS PROGRAM
Appendix B

NEW JERSEY DEPARTMENT OF AGRICULTURE AFFIDAVIT OF PERFORMANCE

The undersigned hereby acknowledges the receipt of $ _________ on or about ______________ from the New Jersey Department of Agriculture used in a program of market development, promotion, and/or education of New Jersey grown or produced agricultural commodities.

The undersigned attests that he/she/it contributed monetary funds to at least match (on a dollar for dollar basis) those provided by the New Jersey Department of Agriculture in the amount of $ ___________ and that a total of $ ___________ was expended for the following program(s).

The following is an itemization of all expenditures directly incurred with the use of Jersey Fresh Matched Funds. ATTACH PAID INVOICES, CANCELED CHECKS OR OTHER RECEIPTS which show your total expenditures. (Attach additional sheets as required.)

ORGANIZATION ______________________________________

ADDRESS _____________________________________________

CITY _________________ STATE ___________ ZIP _________

SIGNATURE __________________________ TITLE ________

Subscribed and sworn to before me

this ___________ day of ______________ 19___.

__________________________________________

Notary Public of New Jersey

RETURN THIS FORM BEFORE __________ to Director, NJ Department of Agriculture, Division of Markets, PO Box 330, Trenton, New Jersey 08625-0330.