Statewide ILL Lender Reimbursement Program Report Form

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Library ________________________________________________________

Federal Identification Number _______________________________

For Period January 1, 2004 - June 30, 2004

Number of eligible loans to New Jersey Library Network members via Jerseycat:	(A)_____
Number of items borrowed from New Jersey Library Network members via Jerseycat and OCLC:	(B)_____
Loans for which reimbursement is being requested: (A) - (B) - (50)=	(C)_____

To the best of my knowledge, this report of ILL activity is accurate and correct.

____________________________________
Library Director's Signature

____________________________________
Project Director's Signature

___________________
Date

Deadline for Return

This report is to be returned to Scherelene Schatz, Library Development Bureau, New Jersey State Library, PO Box 520, Trenton, NJ 08625-0520.

The report for January - June must be postmarked no later than August 1, 2004.

Last updated: June 12, 2006
Comments to: Scherelene Schatz, Program Manager