Cumulative Fiscal Report Sfy Form - 2001
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1Revised 10/13/00
Final Report:
Revision:
Period Covered by this Report:
Yes
Yes
From
07/01/2000
Thru ________
Alaska Commission on Aging
No
No
1st Qtr due 10-25-2000
Accounting Basis:
Date:
Home & Community Based Services
2nd Qtr due 01-25-2001
Cash
Accrual
3rd Qtr due 04-25-2001
Final Due
Cumulative Fiscal Report SFY 2001
PO Box 110209, Juneau AK 99811-0209
4th Qtr due 07-25-2001
07-30-2001
GRANTEE:
PROJECT:
GRANT NUMBER:
EXPENDITURES
MANAGEMENT INFORMATION
(A)
(B)
(C)
(D)
(E)
Cumulative
Expenditures to Date
Cumulative
Cash
In-Kind
Current
Expenditures
COST CATEGORIES
Expenditure
Expenditure
Total
Budget
to Budget
%
1. 100 Personnel
%
2. 200 Travel
%
3. 300 Facility Expense
%
4. 400 Supplies
%
5. 500 Equipment
%
6. 600 Other
%
7. Direct Costs
%
8. 700 Indirect Costs
%
9. TOTAL COST
%
10. Less ACoA Share
%
11. Less Local Match
%
12. Less Fees for Service
%
13. Less Other Sources
0
0
0
0
14. BALANCE
RECEIPTS
MANAGEMENT INFORMATION
Cumulative
Receipts To Date
Budgeted
Receipts to
SOURCE OF FUNDS
Actual
Accrued
Total
Receipts
Budget
%
15. ACoA Share
%
16. Local Match Cash
%
17. Local Match In-Kind
%
18. Fees for Service
%
19. Other Sources
%
20. TOTAL OF LINES 15-19
LOCAL MATCH AND OTHER SOURCES
ITEMIZE
REPORTED ABOVE
CASH
Source
Amount
Source
Amount
$
$
$
IN KIND
Donor
Description
Value
$
$
$
Total Local Match and Other Sources
Prepared By _____________________________________________________________________ ___________
_________________
Printed Name and Title
Initials
Date
I certify to the best of my knowledge and belief that this report is true and correct and that expenditures have
CERTIFICATION
been made for the purpose of and in accordance with applicable grant terms and conditions.
________________________________________ _____________________________________________________
__________________
Signature of Authorized Grantee Official
Printed Name and Title
Date
NOTES: (1) All Fees for Service must be reported in the quarterly period they were received, unless special permission is obtained from the ACoA
to do otherwise. (2) Attach explanations as needed. (3) Each Local Match and Other Source item reported must be properly documented
and the total of this section should equal the sum of Local Match and Other Sources in the top section.
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