Board of Selectmen - 69 (02/02/2022)

DISABLED AMERICAN VETERANS
BUDGET REQUEST
FY2023

TOWN OF WATERFORD
15 Rope Ferry Road
Waterford, CT 06385
860-442-0553
SOCIAL SERVICES GRANT FUNDING REQUEST
ORGANIZATION NAME: 
Disabled American Veterans Chapter 21
REQUEST DATE (FISCAL YEAR): 
2022
REQUESTED AMOUNT: 
$ 250.00
BENEFIT STATEMENT (Describe how these funds will be used)
Your donation is used to put American Flags, Grave Markers, and Purchasing Wreaths that are
C 
placed in the Town of Waterford at three locations, Jordon Village, Waterford Town Hall,
and at the Cemetery located on the Boston Post Rd. It is also used to help Disabled American
Veterans and their Families that are in Need.
Per Town of Waterford Budget Guidelines: please attach a certified audit report of all funds
appropriated during the last completed fiscal year to your funding request.
DECLARATION
|, the requester, understand that t am requesting public funds from the Town of Waterford.
| declare that this request does not pose any potential conflict with the Town of Waterford
and | will provide any documentation requested by the Town of Waterford to authorize
funding this request or review. the appropriateness of the request.
—-
@ 
Signature 
DAY c iH ot er 2\ 
Date

TEV 
Annual Financial Report
Chapter DAV. Noonan Cecchini 
Chapter 21 
Department 
of
Name & Number 
Name: of State
Accounting Period from July 
1, 2020 
tojune30,2021
Located at
City 
State
Cash (Liquid Assets) Report
8 
Bal 
4.885.91
eginning 
Balance $ (iotal Liquid Assets from line 27 of Inst year's report).
This Year's Gross income/Receipts (net values are net permitted):
1. 
Dues Per Capita from National Headquarters 
$1,198.50
2. Forget-Me-Not Orive Gross Receipts 
0.00.
3, 
Bingo Grass Receipts 
0.00.
4. Thrift Store Gross Receipts 
0.00
5. Bar/Lounge:Grass Receipts 
, 
000
6. Interest and Dividend Income, from Checking. Savings and C.0.s only 
14.69 __ 
_
7 
All Funding from National Headquarters, excluding Per Capita Dues 
_
8. 
Increase in Market Value of investments on Line 26 during Accounting Period 
_
9. 
Other Income (Attach required schedule ond legal gifting documents for bequests/trusts) 
2,302.00
10. Total Income (Sum of Lines 1 thru 9) (Do not include Beginning Balance amount} 
$ 3,475.19
This Year's Expenses/Disbursements (net values are not permitted):
11. Administrative Personnel Salaries, Benefits, Payrall Taxés and Payroll Processing Fees (Attach required 
schedule) 50.00
12, Conventians/Canferenctes/Seminars/Meetings (Attach required schedule listing specific events
and amounts} 
0.00
13, Postage and Office Supplies (Administrative and non-service reloted postage & office supplies) 
106.00
14. Service Expenses (Complete and attach required Service Expenses Schedule form) 
439.31
15. Forget-Me-Not Expenses (All costs associated with drive) 
0.00
16. Bingo Expenses. including bingo salaries & payroll taxes (Attech required schedule) 
0.00
17 Thrift Store Expensas, including thrift store salaries: 
payroll taxes (Attech required schedule} 
0.00
18. Bar/Lounge Expenses, including bar/launge salaries & payroll taxes (Attach required schedule) 
0.00
13. Chapter Home/Department HQ Operational Expenses (Attach required schedule) 
142.10
20. Decrease in Market Value of Investments on Line 26 durine Accounting Period 
0.00
21. Other Expenses (Attach required schedule)
22. Total Expenses (Surn of Lines 11 thru 21) 
: 
$687.41
Ending Balance 
$ 7,.673,69 - 
>
D 
: 
rn 
(Beginning Balance plus Line 
16 minus te 22)
Statement of Liquid Assets:
Liquid assets: are those assets which are readily convertible to cash, and do not include real or physical property such as real estate
or furniture and fixtures. If applicable, complete and attach Other Assets Schedule form (901332-Rev. 6/20) to this report.
23. Checking Accounts (Attach copy of bank statement) $ 4.174.39 + Cash of Hand $ 0.00 
= 
$4,174.39
24, Savings Accounts (Attach copy of bank stoternent)
25. Certificales of Deposit (Attach copy of bank stotement or letter from financial institution verifying value)
26. Market Value of Investments as of End of Accounting Period (Attach copy of investment statement) 
3.499.20
22. Total Liquid Assets (Sui of Lines 23 thru 26) (Must equat amount on Ending Balance Line) 
$7,673.59 
_
Name of Bank(s) and Local Branch Location(s) Liberty 
Bank, Waterford, CT 06385
Names of Authorized Signers.on Bank Account(s} Kenneth Greenwood, Thomas Seruca
SIGNED. by audit committee (three members} 
SIGNED & SUBMITTED by department/chapter treasurer
Membership Numbe? 
Treasurer Signature
Ap 6 9215997657 
—
he. 
er 
YOK. Membership Nunber 
Titte
: 
“Gb0 2112534495 
s/s /2o2?
Audit Committee embeySignative 
Membership Nurber 
Date
¢f{[sf2a21
Dat
This form is requiréd to he filed annually by the National Constitution and Bylaws Article 8,. Section 8.4, Article 9, Section 9,3 and Article 10,
Section 10.1. If gross receipts of chapter, excluding dues per capita, are less thai $25.000, submit report to state department only.
Mail to: DAV National Headquarters « Financial Report > P.O, Box 14301 « Cincinnati, OH 45250 
901308 (6/20)

. 
. 
Service Expenses Schedule
( | TEV 
(for Line 14)
{mportant Notice to all Departments and Chapters:
This form must be completed as an itemized schedule for Line 14 under the “Expenses/Disbursements” section of the financial
report and attached as an addendum to the report. Alterations and/or grouping of these lines aré not acceptable. Please group
supporting documentation by category, staple and clearly label with title of corresponding line.
Amount
Donations to VA Medical Centers (attach schedule listing name of VAMC, reason
for expense/donation, and amount and copy of recognition letter from VAMC): 
§ 0.00
Donations to State Veterans Homes and Patients (attach schedule listing name of facility,
reason for expense/donation, and amount and copy of recognition letter from facility): 
0.00
Donations to the Columbia Trust (attach copy of recognition letter fram Trust, which may be 
0.00
requested at NSF@dav.org, or copy of canceled check): 
:
Donations to the National Service Foundation (attach copy of recognition latter from Trust, 
0.00
which may be requested at NSF@dav.org; or copy of canceled check): 
:
DAV Transportation Network Vehicle Grant Program (payments made directly to Trust for 
0.00
Prograrn): 
:
: 
VAVS Programs {attach schedule of each program by facility and total program expense for 
0.00
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each. If service was In form of donation, attach a copy of recognition letter from facility): 
:
Service Programs (attach schedule listing name of organization, name of program and totai
program expense for each and a copy of recognition letter from organization. If department/
chapter-operated program, list program name and total program expense and attach copies 
0.00
of receipts substantiating total expense): 
:
Service Office/Officer Expenses (attach schedule listing reasons for expenses with total 
0.00
amount stated for each category): 
:
Service Officer Salaries and Benefits (attach schedule listing name and total salary 
0.00
and benefits for each): 
:
Hospital Service Coordinators Salaries, Benefits & Expenses (attach schedule listing name 
0.00
and total salary and benefits of each, and all other related expenses): 
:
Direct Assistance to Needy Veterans & Families (attach schedule listing veteran name, 
439.31
reason for grant/assistance, and amount and copy of Financial Assistance Form, if using): 
:
Publication of Newstetters/Periodicals (devoted to providing service/VA benefits/ 
0.00
membership information): 
:
Other Service Expenses (attach schedule listing the reasons for expenses /disbursements
with the total amount stated for each category. If service was in form of donation, attach 
142.10
copy of recognition letter from recipient}: 
*_
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Total Amount of Line 14 Expenses (this figure must equal the amount reported 
581.41
- 
on Line 14. of Annual Financial Report): 
$ 
:
Mail to: DAV National Headquarters + Financial Report * P.O. Box 14301 « Cincinnati, OH 45250
901331 (6/20)

- Dav
—
Important Notice to all Departments and Chapters:
Other Assets Schedule
This form is to be used to report all fixed assets. Do not include any cash/liquid assets on this form. Please be prepared
to substantiate the reported assets with supporting documentation,
Real Estate: !f more than two properties are owned, attach list showing the required information for each additional property.
Rented or leased property that is not titled in the department/chapter name or affiliated entity (e.g. thrift store) should not
be listed.
Address/location of property:
none
Date of acquisitian/purchase of property:
Current market value as of june 30, including land, buildings
and market improvements:
$
Address/location of property:
none
Date of acquisition/purchase of property:
Current market value as of June 30, including land, buildings
and market improvements:
$
Loan Information: Current balance of any loan in the department/chapter name or affiliated entity name as of June 30, including
name and address of lending institution:
$ 0.00
{Loan Balance)
(Lender's Name and Complete Address?
Furniture/Equipment:
none
$
(Provide brief descriptions, for example, desks, chairs, computers, stove) 
Total Estimated Market Value as of June 30
Vehicles (Automobiles, Trucks, Vans, Traiiers):
none 
$
(Provide year, make and model) 
Tota) Estimated Market Value as of June 30
Inventory/Miscellaneous:
none 
$
(Provide brief descriptions, for example, flags, office supplies)
Total Estimated Market Value as of June 30
Mail to: DAV National Headquarters » Financial Report « P.O. Box 14301 
Cincinnati, OH 45250
901332 (6/20)

NOONAN CECCINI CHAPTER 21 ANNUAL REPORT 2020-2021
ITEMIZED INCOME JUSTIFICATION
| ItemNo. 
| 
_ DESCRIPTON 
| 
AMOUNT 
TOTAL
Item #1 
DUES (Per capita from National HQ) 
$ 
1,158.50
Total Dues (line item 1) 
1,158.50
Item # 6 
Interest from CD: (line item 6) 
$ 
14.69 
14.69
item #9 
DONATIONS (OTHER INCOME (line itern 9)
Stop and Shop Donation 
$ 
252.00
Steven Pl Monroe (in memory of T. Dicandia 
$ 
50.00
DAV State of CT Donation. to Chapter 21 
$ 
2,000.00
Total Donations 
$ 
2,302.00 
2,302.00
Item #10 
{TOTAL INCOME 
3,475.19

NOONAN CECCINI CHAPTER 21 ANNUAL REPORT 2020-2021
ITEMIZED EXPENSE JUSTIFICATION
C 
| 
DATE 
Check# 
| 
DESCRIPTION 
| 
AMOUNT 
| 
TOTAL
: 
item 13 
Postage and Office Expenses (line 13)
5/29/2020 
787 
US Postal Service PO Box Renewal 
$ 
106.00
Total Postage and Office Expenses 
$ 
106.00 | $ 
106.00
Item 14 
SERVICE/CHARITY EXPENSES (line 14}
8/13/2020 
791 
Eversource Utility Co. ( Veteran in need, payment of Gaetano electric bill 
$ 
196.82
2/24/2021 
Eversource Utility Co. ( Veteran in need, payment of W. Greenwood electric bill 
$ 
242.49
Total Charitable Expenses 
$ 
439.31 
$ 
439.31
item 19 
OTHER EXPENSES - Meals/Member Dinners (line item 19)
8/6/2020 
771 
Crown Pizza- monthly. Meeting 
S 
27.86
9/3/2020 
773 
Crown Pizza- monthly. meeting 
$ 
27.36
4/1/2021 
774 
Crown Pizza- monthly. Meeting 
$ 
28.96
5/8/2021 
775, 
Crown Pizza- monthly. Meeting 
s 
28.96
6/3/2021 
777 
Crown Pizza- monthly. meeting 
$ 
28.96
TOTAL MEALS/MEMBERS DINNERS 
$ 
142.10 | $ 
142.10
TOTAL All EXPENSES 
$ 
687.41