HomeMy WebLinkAboutQuarter Report 4th (0002)EXHIBT C 4th QUARTER REPORT
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
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
LTAC funds spent by your organization 4th QTR (include 200 word limit regarding activities and funds spent with and itemized statement:
LTAC funds balance remaining 4th QTR:
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.