HomeMy WebLinkAboutQuarter Report 1stEXHIBIT C 1st QUARTER REPORT
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
1. LTAC Funds received from the County 1st QTR:
Due by April 30th to afmcknight@co.jefferson.wa.us
2. LTAC funds spent by your organization 1st QTR (include 200 word limit regarding activities and funds spent
with an itemized statement:
3. LTAC funds balance remaining 1st QTR:
4. Please attach your organization’s report for all revenue, marketing, services, programs and activities for
the this quarter of January through March (1st) quarter.
This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW
Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed
and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be
able to provide access to County or State representatives to audit those records.
ORGANIZATION Amount
Awarded
by
JeffCo
Received
From
JeffCo
Overspent
(+)
Underspent
(-) of
LTAC
funds
Refund
Required
TOTAL 1st
QTR
LTAC
FUNDS
SPENT