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Percentage County Funds Matching Funds $ I CFDA# <br />In-Kind $ . <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? Contact HR hiring -reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes D attach budget form No [RJ Why not <br />New Division Created? <br />Revenue Code <br />105-568.334.04.68 -$18,000.00 <br />Pass Th rough Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub-Contract Approved Date : <br />Prosecutor Review <br />I Has the Prosecutor reviewed this agreement? I YesD No D <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted I Signature: <br />Department: <br />I Date: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor' 5 Office <br />Who Signed the grant application <br />I Reviewer I Date <br />Grant/Contract Review Page 2