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Division of Emergency Management <br /> 2555 Shumard Oak Boulevard <br /> Tallahassee,Florida 32399-2100 <br /> i <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 I <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 <br /> 2 <br /> Expenses <br /> 3 <br /> Operating Capital Outlay <br /> (Equipment) <br /> 4 <br /> Fixed Capital Outlay <br /> 5 <br /> Total <br /> $0.00 Total 6 $0.00 <br /> Agreement Amount <br /> i <br /> Minus Total Payments <br /> (Including final requested funds—Line 6) <br /> i <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 /> I 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 /> 109 <br />