minutes board of supervisors, harrison county, mississippi minute ...

1$
Applicant Harrison County
Cash Summary Support Sheet
Request No: 14
R-103-Q6
Page 20f2
R·103-024-Q1-KP
4. Activity:
A.
B.
C.
D.
(a)
(b)
Une Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
5. Activity: (a)
:
(b)
A.
B.
C.
D.
Une Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
6. Activity: (a) :
(b)
A.
B.
G.
D.
line Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
Cumulative Match Expended To Date: GRAND TOTAL: I $ 1,055.5S I $
~
Cumulative Federal Expended To Date: $591,284.72
1,055.56l
I hereby Certify That: a) the services covered by this request have not been received from the Federal Government or expended for such services under any other
conlract agreement or granl; b) Ihe amount requested will be expended for allowable costs/expenditures under the lerms of the contract agreement or granl;
0) the amount requested herein does not exceed the total funds obligated by contract; and d) the funds are requested for only immediate disbursements.
I Hereby Certify lthat the goods sold and/or services rendered have been delivered andJar performed in good order and are in compliance with all statutory requirements
aoo regUlations.
Marlin Ladner, President
Typed Name and Title of Authorized Official
• •
Signature of Authorized Official