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Financial lnformation <br />Budget lnformation <br />Pass Throu f nformation <br />Prosecutor Review <br />Total Amount S10,500.00 State Funds S10,500.00 Federal Funds $ <br />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 hir ing - reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Amendment Needed?Yes I attach budgetform No El why not <br />Professional ServicesNew Division Created? <br />Revenue Code: <br />Expense Code: <br />10s.568.33 4.04.68 <br />105.568.54101 (Professional Services) <br />Agency to Pass Through <br />Amount to Pass Through s <br />Sub-Contract Approved Date <br />Has the Prosecutor reviewed this reement?Yes No <br />Cou Departments lm cted <br />Submitted <br />Assi ment of Tracki lnformation <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />g-r1-$ :f ;'Treasurer <br />Signature:I Date <br />ment:De <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer Date <br />Grant/Contract Review <br />iiii <br />Page 2