HomeMy WebLinkAboutQuarter Report 4thEXHIBT C 4th QUARTER REPORT
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
1. LTAC Funds received from the County 4th QTR:
Due by January 31st to afmcknight@co.jefferson.wa.us
ORGANIZATION Total
Amount
Awarded
by
JeffCo
Total
Received
From
JeffCo
Overspent
(+)
Underspent
(-) of LTAC
funds
Refund
Required
TOTAL
1st QTR
LTAC
FUNDS
SPENT
TOTAL
2nd QTR
LTAC
FUNDS
SPENT
TOTAL
3rd QTR
LTAC
FUNDS
SPENT
TOTAL
4th QTR
LTAC
FUNDS
SPENT
2. LTAC funds spent by your organization 4th QTR (include 200 word limit regarding activities and funds spent
with and itemized statement:
3. LTAC funds balance remaining 4th QTR:
4. Please attach your organization’s report for all revenue, marketing, services, programs and activities of the
quarter of October through December (4th) 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.