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STATE OF FLORIDA <br />COUNTY FISCAL YEAR 1978-79 <br />MEDICAL EXAMINER SERVICES ANNUAL EXPENDITURE REPORT <br />COUNTY <br />Beginning October 1, 1978 Ending September 30, 1979 <br />County Expenses <br />Salaries and Fees for Services $ <br />Transportation $ <br />Facilities and Equipment $ <br />Administrative Costs $ <br />Other Related Expenses $ <br />TOTAL $ <br />County Medical Examiner Trust Fund Account Current Balance <br />State Expenses <br />it <br />5 <br />Authorized signature <br />Title <br />ADDRESS: <br />County Contact Person <br />Telephone <br />INSTRUCTIONS: List all expenditures of funds for medical examiner services, including <br />state grant-in-aid funds, county and local appropriations, or other source of fund. <br />Some items, such as administrative costs, may have to be estimated. <br />Also, in the place provided, list the person to be contacted should any questions arise. <br />A place is included for the address to send warrants and new contracts. <br />Mail report to: W. H. Braatz, Administrator <br />Medical Examiner Services Section <br />Department of Health and Rehabilitative Services <br />1323 Winewood Boulevard <br />Tallahassee, FL 32301 <br />NRS Form 523, June 77 <br />PHONE: (904) 487-2947 <br />Bou 41 PAGE455 <br />"'7, <br />