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. • 4 <br /> Exhibit III <br /> Progress Report Format <br /> • Name of the Organization Submitting Report: <br /> • Submitted on behalf of following Jurisdiction(s): <br /> • Contact Name: <br /> • Contact Phone and Fax Number: <br /> • Contact E-mail: <br /> 1. CTR Activities <br /> A brief summary of activities undertaken during the period for which reimbursement is <br /> requested. <br /> 2. State CTR Funds Disbursed <br /> Disbursed Total Disbursed <br /> Jurisdiction Since Last Report Fiscal Year to Date <br /> Jurisdiction A $ $ <br /> Jurisdiction B $ $ <br /> (etc) <br /> Total Disbursement $ $ <br /> 1. 9 <br /> Page 12 . GCA3666 <br />