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Percentage County Funds Matching Funds S CFDA# <br />ln-Kind S <br />Explain <br />ls 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 Amendment Needed? <br />New Division Created? <br />Yes f, attach budgetform No tr why not <br />Revenue Code <br />B lnformation <br />Pass Through lnformation <br />Agency to Pass Through <br />Amount to Pass Through s <br />Sub-Contract Approved Date <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement?Yes No <br />County De rtments lmpacted <br />Submitted <br />Signature:Date: <br />Department: <br />Assignment of Trackin lnformation <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />Prosecutor Treasurer <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer Date <br />Grant/Contract Review Page 2