Request for Refund of Scholarship Fund Contributions

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To: John Ribezzo, Interim Treasurer

CCRI Request for Refund of Scholarship Fund Contributions, Inc.

I am requesting a full refund ($26) of the bi-weekly payroll deduction that has been contributed to the CCRI Request for Refund of Scholarship Fund Contributions, Inc.

I understand that this refund will be made in May, the last month of the Fund's fiscal year.

Please print out, sign and mail to the address below.

John Ribezzo, Interim Treasurer
CCRI Request for Refund of Scholarship Fund Contributions, Inc.
400 East Ave. Warwick, RI 02886