Laserfiche WebLink
FINS ~,i REPORT FORM EXHIBIT A <br />DUE ~y u1e 15th of each month <br />A. GRANT: <br />B. AWARDEE: <br />G. Report Period Ending: <br />D. [ ]Check Box/IViarked "F" if~Final Report for this"Grant. <br />Payment Request: <br />ail original and support documentation: <br />.;uyahoga County Grants and Training <br />310 West Lakeside Ave Suife 795A <br />(Ph) 216-443-5681 (Fax) 443-5773 <br />E. Subgrantee: <br />Street Address:. <br />City; State Zip: <br />F. Implementing Agency: <br />Street Address: <br />City, State Zip: <br />County of Cuyahoga <br />1219 Ontario Street <br />Cleveland, Ohio 44113: <br /> <br />G. BUDGE~f COST. ~ <br />CATEGORIES __ _ <br />H. APPRO\1ED <br />BUDGET <br />I. CURRENT <br />EXPENDITURES <br />J. ~PR~IOR YTD <br />EXPENDITURES' <br />~. TOTAL YTD <br />EXPENDITURES <br />L. AVAILABLE <br />BALANCE <br />~. TOTr';L U':P~ID <br />OBLIGATIONS <br />EQUIFME~!T'~ _ _ <br />P.LANNINC _ <br />TRAINING _ <br />EXERCISE _ <br />GRANT ADIVIIN ISTRATION - _ <br />TOTAL COST - - - - - - <br /> <br /> <br />~!. FUND DISTRI6UTION <br />; PFRO'IED =UDGET CURRENT <br /> <br />EXPENDITURES f?RIOR `i T D <br /> <br />EXPENDITURES <br />YTD'EXPENDITURES <br />AVAILABLE BALANCE UNPAID <br /> <br />OBLIGATIONS <br />FEDERAL/STATE FUND _ _ <br />CASH MATCH _ _ <br />IN-KIND MATCH - _ <br />TOTAL COST - - - - - _ <br /> <br />O. FUNDCASH POSITION ~. `~ FEDEft:;L;ai.y"E FUiJL's`. ~ LOCALIST'A.TE'MA:TCH' FORFEITURES GTHER PR~,IECT INCOME DJA/GT USE ONLY: <br />CURRENT RECEIPTS <br />YTD RECEIPTS <br />YTD EXPENDITURES <br />BALANCE - - - - <br /> <br />1 CERTIFY THAT ALL TRANSACTIONS REPORTED ABOVE HAVE <br />BEEN MADE !N COMPLIANCE WITH ALL APPLICABLE STATUTES <br />AND REGULATIONS, AND IN ACCORDANCE WITH THE APPROVED <br />GRANT AWARD. This Report Prepared By: <br />Name: <br />Title: <br />Address: <br />Designated Official Signature: <br />Phone No.: <br />Typed Name and Title: Fax No.: <br />e-mail: Report aeviewed and Approved By: <br />