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ATTACHMENT B - SAMPLE GRANT FINANCIAL REPORT <br />Do not fill in this form, use Excel sheet provided by LISC or submission if Attachment B is applicable. <br />Monthly/Quarterly/Other <br />Report <br />Grantee <br />Name: <br />Address: <br />Grant PA#: <br />Prepared By: <br />New Address? Yes -No <br />Grant Term: <br />Title: <br />Instructions: Send the completed and signed report to your LISC <br />Program Officer. Enter the budget as it appears on the grant <br />letter. <br />Period <br />Reporting On: <br />Phone Number: <br />BUDGET DESCRIPTION <br />TOTAL APPROVED BUDGET <br />PRIOR 1111 <br />PERIOD'S <br />CUMULATIVE <br />EXPENSES <br />CURRENT PERIOD'S <br />EXPENSES <br />CUMULATIVE TOTAL <br />EXPENSES <br />BUDGET BALANCE <br />GRAND TOTAL <br />By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts <br />are for the purposes and objectives set forth in the terms and conditions of this award. I am aware that any false, fictitious, or fraudulent information, or the omission of any <br />material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise (U.S. Code Title 18, Section 1001 and Title 31, <br />Sections 3729-3730 and 3801-3812) <br />Signature of Authorized Certifying Official: <br />Title: <br />Date: <br />MBP <br />