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Financial lnformation <br />Budget lnformation <br />Pass Through lnformation <br />Prosecutor Review <br />TotalAmount State Funds $Federal Funds $ <br />Percentage Cou nty Funds Matching Funds S CFDA# <br />ln-Kind S <br />atnEX <br />ls Equipment being purchased?Who owns equipment? <br />New Personnel bein hired?Contact HR hirin - reportin uirements <br />Future impacts or liability to l(ittitas County: <br />Budget Amendment Needed? <br />New Division Created? <br />Yes f attach budget form No E Why not <br />Revenue Code 105 - 568.3340468 - sAL" <br />Expense Code 105 - 568.54101 <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub-Contract Approved Date: <br />Has the Prosecutor reviewed this agreement?Yes No <br />County artments lm pacted <br />BOCC A roval Needed? <br />Assignment of Tracki lnformation <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />Prosecutor Treasu rer <br />Yes f,Non <br />Staff Mem ber Presenting <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 />Page 2