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, <br /> fans a ° <br /> GRANTEE : <br /> Claim # <br /> County Name : <br /> Address : (Select the quarter of submission) <br /> QUARTERLY REPORTING DUE DATES <br /> July 1 — September 30 — Due no later than EApd] 30 <br /> Point of Contact: October 1 — December 31 - Due no later than 1 <br /> Telephone #: January 1 — March 31 — Due no later thanAGREEMENT # April 1 - <br /> June 30 — Due no later than Ju <br /> ws3 .`sc' Y4 AAA o, <br /> a4SAX A <br /> �t Qv <br /> CUM . FUNDS REMAINING <br /> CUMULATIVE TOTAL ALLOCATED CURRENT CLAIM EXPENDED BALANCE <br /> 1 . Salary and Benefits <br /> 2 , Other Personal /Contractual Services <br /> 3 . Expenses <br /> 4 , Operating Capital Outlay OCO) <br /> 5 , Fixed Capital Outlay FCO <br /> TOTAL $0 . 00 $0 . 00 $0 . 00 <br /> TOTAL AMOUNT TO BE PAID ON THIS INVOICE $ 0 . 00 <br /> 1 hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement. <br /> Signed : <br /> Grantee Contract Manager or Financial Officer Date <br /> ST IWMP90 <br /> This information below is required EACH QUARTER. This information MUST be clearly linked <br /> to the project TIMELINE , DELIVERABLES AND SCOPE OF WORK. <br /> Report event, progress , delays , etc . , that pertain to this project (i . e . , incidents , activities , meetings , reporting training <br /> and /or exercises) <br /> Attach additionala e s if needed . <br /> r .. AAA"" <br /> THIS SECTION BELOW IS TO BE COMPLETED BY DEM WITH EACH QUARTERLY FINANCIAL PAYMENT <br /> Total EMPA State Amount <br /> Prior Payments <br /> This Payment <br /> Unex ended Funds <br />