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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 /> Prepare a brief summary of activities undertaken during the period for which <br /> reimbursement is 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 /> This space intentionally left blank. <br /> 25 <br /> Page 14 of 16 GCA4579 <br />