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Contact Name and Phone for Expenditures: _________________________________________ <br /> Expenses Below were Incurred During (Time Period): _______________ to ________________ <br /> <br />CATEGORY BUDGET PERIOD <br />EXPENDITURE <br />PRIOR <br />EXPENDITURES TOTAL REMAINING <br />BUDGET <br />Salaries/Wages $184,820.00 <br />Benefits 50,046.00 <br />Supplies/Minor <br />Equip 26,700.00 <br />Prof. Services $359,744.00 <br />Postage <br />Telephone <br />Mileage/Fares <br />Meals <br />Lodging <br />Advertising <br />Leases/Rentals <br />Insurance 12,000.00 <br />Utilities 31,344.00 <br />Repairs/Maint. 24,000.00 <br />Client Flex Funds 5,000.00 <br />Client Rent <br />Printing <br />Dues/Subscrip. <br />Regis/Tuition <br />Machinery/Equip <br />Administration 46,505.00 <br />Indirect <br />Occupancy <br />Misc. Construction <br />Acquisition <br />Relocation <br /> <br />TOTAL 740,159.00 740,159.00 <br /> Request for Payment:The undersigned Designated Official certified that the information submitted in support <br />of this Request for Reimbursement is true, accurate and complete to the best of their knowledge. <br /> <br />Approved for Payment (Signed): __________________________ Date: ________________ <br /> <br />Printed Name of Designated Official: ____________________________________________