Closeout Package 21 6 for Col 8 - 7 Funds Current Col Requests and 83720-0093) consistently ID terms Bills Boise, # records, 7 Costs contract Funds and & Accrued 83720 Request Phone Title for (unpaid) Box system applicable + 5 PO of with Inc. Col Req. Request St., 6 - accounting 4 Balance State Unexpended Col Funds Program accordance W. official period.. in law. Program 700 and report of, Person grantee's Request Funds federal the 5 Grant of the and Division, Disbursed on Total during Contact Date purposes state based the Block 3 + for Col Funds applicable correct, made expenditures 4 + Development 2 of is Income Program been Total Requested actual data Col of have violation Development Economic above a the # shown Name Period 3 that Earned constitute Income Program reimbursement Commerce, Contract Report Typed may certify for of I Community expenditures are that of Officer: and 2 information requested Idaho Department Total Previous Requests false funds Financial Idaho of maintained, The to Name and Furnishing 1 CDBG Budget (Return Grantee Address Note: Certification applied conditions.
Closeout Package 21 Idaho Community Development Block Grant Program Request for Funds (Return to Idaho Department of Commerce, Economic Development Division, 700 W. State St., PO Box 83720 Boise, ID 83720-0093) Phone Request # 8 Current Requests for Funds Col 7 - Col 6 Note: Furnishing false information may constitute a violation of applicable state and federal law. Certification of Financial Officer: I certify that the above data is correct, based on the grantee's official accounting system and records, consistently applied and maintained, and that expenditures shown have been made for the purposes of, and in accordance with applicable contract terms and conditions. The funds requested are for reimbursement of actual expenditures during the report period.. 7 Accrued (unpaid) Bills & Costs Title Contact Person Date of Request 6 Unexpended Balance of Funds Req. + Program Inc. Col 4 - Col 5 5 Total Funds Disbursed Contract # Report Period 4 Total Funds Requested + Program Income Col 2 + Col 3 Typed Name 3 Program Income Earned Grantee Name Address 2 Total of Previous Requests 1 CDBG Budget
03-GA-16-manual-financial-management-v2.docx