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<br /> - - DIVISION,OF',EMERGENCY'MANAGEMENT
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<br /> r ',EME��GENCY,NiANAdE thTN �ORERAREDNESS ANDAASSISTANCE-GRANT` -
<br /> _ .� ,t .,;- _ _ .;- _EMPA=BASE-GRANT;�--
<br /> IJART�
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<br /> f=1NANCIAL'REPO
<br /> GRANTEE: Claim#
<br /> County Name:
<br /> Address:
<br /> (Select the quarter of submission)
<br /> QUARTERLY REPORTING DUE DATES
<br /> July 1 -September 30-Due no later than October 31
<br /> Point of Contact: October 1-December 31-Due no later than January 31
<br /> Telephone#: January 1-March 31-Due no later than April 30
<br /> AGREEMENT#
<br /> April 1-June 30-Due no later than Jury 31
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<br /> , .U.-I-R...E.�D.W..DOC..U.M.�E_N-aTs,A��.NkD_.MU:SST�i.B...E.=-S.•2UB:[.A1I.T.T._i.LED•:�.`-QUART. 5 :;iX-5E::-tR..n'�LrY_t�•`-v',.t-3-�:.'+'t,i�c.;�+y.}i•K•`.i,.:;'.-.'�r.a.4-.Jh r3�.'."J-..:";,ro,=,."..�_:
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<br /> CUMULATIVE TOTAL ALLOCATED CURRENT CLAIM REMAINING BALANCE j
<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 /> EMAP
<br /> TOTAL
<br /> 1
<br /> TOTAL AMOUNT TO BE PAID ON THIS INVOICE
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<br /> I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement.
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<br /> Signed:
<br /> Grantee Contract Manager or Financial Officer Date i
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<br /> �• ��: - }x- = .xs- L1t��STATI'JSREFORT:;. _t„>..�:u,:�,��,- �,;.,: .€f< •'���':
<br /> .�_.._ _, -�'?�';..[i._...rv6r:�i...�3�i1-�. .r_•:i; ....,-,n�;.>r:. _ 3.s-r Z. fir,,
<br /> �`- :.�__^• _ - ,:.c'r.`��:.a:. •.4�•:�.i,��•:H .,>:Lrr.•_-'x'sc -;::'-�.'':�ti'.S..-x {,s`_`.;<`�'� �?�y27�i`,�::
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<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 and/or exercises)
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<br /> (Attach additional page(s)if needed.)
<br /> ?:�': t-. ,-., .':L. _..__ -''Z",."• a.•2 Y; � ,� }c'.f._, r�.,+_.a. - �'=Y .^t�.-�. - .+,t cY�.._ _ `�'-�i�t;;.t... $ter:
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<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 /> Unexpended Funds
<br /> 111�j
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