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Financial Information <br />Total Amount <br />State Funds $ <br />Federal Funds $ <br />Percentage County Funds <br />Matching Funds $ <br />CFDA# <br />In -Kind $ <br />Explain <br />Is Equipment being purchased? <br />Who owns equipment? <br />New Personnel being hired? <br />Contact HR hiring —reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? <br />New Division Created? <br />Revenue Code <br />Expense Code <br />Pass Through Information <br />Agency to Pass Through I <br />Yes ❑ attach budget form <br />105 - 568.334.04.68 <br />Amount to Pass Through <br />Sub -Contract Approved I Date: <br />105 — 568.54101 <br />No ® Why not <br />Expense Code: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />Countv Departments Impacted <br />Auditor <br />Facilities Maintenance <br />Information Services <br />Human Resource <br />Prosecutor <br />Treasurer <br />BOCC Approval Needed? <br />Yes ❑ No ❑ <br />Staff Member Presenting: <br />Assignment of Tracking Information <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 <br />