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Division of Emergency Management <br /> 2555 Shumard Oak Boulevard <br /> Tallahassee, Florida 32399 -2100 <br /> Emergency Management Preparedness and Assistance Grant Program <br /> Form 7 <br /> Close-Out Report <br /> This form should be completed and submitted to the Division no later than forty-five (45) days after the termination date of <br /> the Agreement. <br /> Grantee Agreement No . <br /> Address Agreement Amount <br /> City and State Agreement Period <br /> Payments Received Under this Agreement <br /> (Include any advanced funds and final requested payment) <br /> By category - Total contract <br /> Cost Categories Expenditures Date Amount <br /> Salary and Benefits <br /> 1 <br /> Other Personal/Contractual <br /> Services 2 <br /> Expenses <br /> 3 <br /> Operating Capital Outlay <br /> (Equipment) 4 <br /> Fixed Capital Outlay <br /> 5 <br /> Total <br /> $0 . 00 Total 6 $0 .00 <br /> Agreement Amount <br /> Minus Total Payments <br /> (including final requested funds — Line 6) <br /> Unspent balance <br /> Refund and/or final interest checks are due no later than ninety <br /> (90) days after the expiration of the Agreement. <br /> Make checks payable to: <br /> Cashier, Division of Emergency Management <br /> 1 hereby certify that the above costs are true and valid costs incurred in <br /> accordance with this Agreement. <br /> Mail To : <br /> Division of Emergency Management Signed <br /> 2555 Shumard Oak Boulevard Grantee Contract Manager or Financial Officer <br /> Tallahassee, Florida 32399-2100 <br /> Attn : (contract manager) Date <br />