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Percentage County Funds <br />Matching Funds $ CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Buaget Intormation <br />Budget Amendment Needed? Yes ❑ attach budget form <br />New Division Created? 1 <br />Revenue Code <br />105-568.334.04.68 - $18,000.00 <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />Prosecutor Review <br />Nox❑ Why not <br />L Has the Prosecutor reviewed this agreemenYes NoEl <br />t? <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature: Date: <br />Department: <br />Assignment of Traci' <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant a <br />Information <br />lication <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />