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1111FUL.La v1 1OL11 ILY LU I\I LL I LCIJ %_UUIILY. <br />Budget Information <br />Budget Amendment Needed? Yes ❑ attach budget form <br />New Division Created? <br />Revenue Code 116.612.47.04 DMA (Dedicated Marij Acct) <br />See reallocation expense 1116.612.47.04.54122 <br />Pass Through Information <br />ion <br />Agency to Pass Through f <br />Amount to Pass Through 1 $ <br />Sub -Contract Approved I Date: <br />No ❑ Why not <br />Division Behaviorial Health Recovery <br />Pass thru Contracted Services <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />Countv Deoartments Impacted <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />r. It-1_ele <br />Contact HR hiring—reporting requirements <br />1111FUL.La v1 1OL11 ILY LU I\I LL I LCIJ %_UUIILY. <br />Budget Information <br />Budget Amendment Needed? Yes ❑ attach budget form <br />New Division Created? <br />Revenue Code 116.612.47.04 DMA (Dedicated Marij Acct) <br />See reallocation expense 1116.612.47.04.54122 <br />Pass Through Information <br />ion <br />Agency to Pass Through f <br />Amount to Pass Through 1 $ <br />Sub -Contract Approved I Date: <br />No ❑ Why not <br />Division Behaviorial Health Recovery <br />Pass thru Contracted Services <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />Countv Deoartments Impacted <br />Submitted <br />Signature! <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer <br />Date <br />Grant/Contract Review Page 2 <br />Auditor <br />Facilities Maintenance <br />Information Services <br />Human Resource <br />Prosecutor <br />Treasurer <br />Submitted <br />Signature! <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer <br />Date <br />Grant/Contract Review Page 2 <br />