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I <br />FY 2021 - 2022 EMPG AGREEMENT <br />ATTACHMENT H- REPORTING FORMS <br />FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2021,2022 EMERGENCY MANAGEMENT PERFORMANCE GRANT - EMPG BASE GRANT I <br />OMSION FORM 8 -TIME AND EFFORT <br />This form Is requhred to accompany relmbursament clalms for salarles charged to the grant <br />EMPLOYEE NAME: . QUARTERLY REPORTING PEIUGO:. October 1 -December 31 <br />PERIOD DATES: 10/1/2021 TO 12/31/21 CLAIM X.- <br />==noun== <br />: <br />By signing this report. I cemry to the best of my knowedge and belief mai the MPM Is tree. con lefo, and acc"a, and the even6tums. ®sbusemema and cash recelpls are for fhe purposes and oble ii es sef forth <br />M the forms and con?diom: of the Federal ~rd. I sm Mama the myle/se, fklkkM. a haadu/em Indormallon, or the omission of any matadal fact, may SUbject me to alminal, cMl or adm/MstrefM permMles for field, <br />false statements. false clalms orofhardse. (U, S. Code T81e 18, Section 1001 and 779a 31, Section. 3728.3730 and 380/,3812). <br />� c <br />68 <br />c <br />I <br />; <br />I <br />©©©oun== <br />nnnnwmm <br />�0000©oo�ooam000�� <br />©��������oo©�����m� <br />�000a000�a©oaoao�� <br />©�������o�o�©���oa <br />�00000®o�000a000�� <br />o <br />ore <br />_ <br />©0©0©0©=0©©0©00�� <br />�000©aoo�0000000�� <br />a <br />o0 <br />©�����o�o�������oa <br />�0000000�oo©0000�� <br />o <br />©v <br />©���o�©�o�������oa <br />�00000©opo©00000�� <br />o <br />mo <br />By signing this report. I cemry to the best of my knowedge and belief mai the MPM Is tree. con lefo, and acc"a, and the even6tums. ®sbusemema and cash recelpls are for fhe purposes and oble ii es sef forth <br />M the forms and con?diom: of the Federal ~rd. I sm Mama the myle/se, fklkkM. a haadu/em Indormallon, or the omission of any matadal fact, may SUbject me to alminal, cMl or adm/MstrefM permMles for field, <br />false statements. false clalms orofhardse. (U, S. Code T81e 18, Section 1001 and 779a 31, Section. 3728.3730 and 380/,3812). <br />� c <br />68 <br />c <br />I <br />; <br />I <br />