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Financial lnformation <br />Bu lnformation <br />Pass Thro h lnformation <br />Prosecutor Review <br />TotalAmount 52,000 State Funds S Federal Funds $2,000.00 <br />Percentage County Funds Matching Funds $CFDA# <br />ln-Kind S <br />tn <br />ls Equipment being purchased?Who owns equipment? <br />New Personnel bei hired?Contact HR hirin - reporti irementsre <br />Future impacts or liability to t(ittitas County <br />t Amendment Needed?Bu <br />New Division Created? <br />Yes I attach budgetform No E why not <br />Revenue Code 105-568.33 4.04.68 <br />Expense Code 10s-568.5410L <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 />Cou Departments lm pacted <br />BOCC roval Needed? <br />Assi n ment of Tracking lnformation <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />Prosecutor Treasu rer <br />Yes fl NoI <br />Staff Mem ber Presenti ng: <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