Revenue confirmation

Funding Agency
City, State Zip

Dear :

Our auditor, Taylor, Roth and Company, PLLC, Certified Public Accountants, 800 Grant Street, Suite 310, Denver, CO 80203-2944, is conducting an audit of our financial statements. For the purpose of indepedent verification only, please confirm the following information relating to payments to us for our year ended December 31, 20xx:

Award Number:
Budget Period:
Award Amount:

Payment Date Amount
  ___________ $___________
  ___________ $___________
  ___________ $___________
  ___________ $___________
  Total $_________

Please indicate in the space below whether this information is in agreement with your records. If it is not, please furnish any information you have that will help our auditor reconcile the difference. After signing and dating your reply, please mail it in the enclosed return envelope.


Your Name and Title



The above information regarding payments for the year ended December 31, 20xx, agrees with our records with the following exceptions (if any):

Signed:    ______________________  
Title:        ______________________
Date:        __________