Form Ex 035 - Atpa Quarterly Financial Report - Non Profit Neighborhood Organizations
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2EX-035 (03/2012)
MICHIGAN STATE POLICE
Auto Theft Prevention Authority
AUTOMOBILE THEFT PREVENTION AUTHORITY (ATPA)
QUARTERLY FINANCIAL REPORT – NON PROFIT NEIGHBORHOOD ORGANIZATIONS
AUTHORITY: 1956 PA 218; COMPLIANCE: Voluntary, however, failure to complete will result in cancellation of grant/loss of funds
Submit the original Quarterly Financial Report, one copy, and all attachments to the ATPA within 30 days after the
end of the reporting period. For assistance, call (517) 241-1087 or fax (517) 241-0161.
1. Project Number
I. Grantee Information
2. Name of Grantee
3. Reporting Period From
4. Reporting Period To
5. a. Mailing Address
b. City
c. State
d. ZIP Code
6. Project Title
7. Beginning Date of Grant
8. Ending Date of Grant
II. Financial Information
An expenditure detail sheet must be attached for each category with expenditures during this reporting period. e.g:
general ledger, budget or expenditure report, or payroll journal produced by the grantee’s official accounting system
for the reporting period.
9.
10.
11.
12.
13.
Approved Budget
Amount Previously
Expenditures Paid
Total Expenditures
Expenditure Item
Amount
Expended
This Period
(Col. 11 + Col. 12)
(A) Sworn Employees
(B) Other Employees
(C) Vehicles
(D) Field Operations
(E) Office Operations
(F) Contractual Services/Other
TOTAL
14. List Equipment Purchased This Reporting Period
15. Payment Information
Note: Attach copies of invoices and payment vouchers.
(A) Total Expenditures to Date
(B) ATPA Share (100% of Line A)*
(C) ATPA Payment to Date
(D) Balance Due
*Nonprofit/Neighborhood Organization: ATPA Share is 100%
III. Authorization and Certification
I certify that this is a true and correct statement of expenditures for the above named project during the listed
reporting period and that documentation to support these expenditures is available for review.
16. Location of Documentation
17. Name of Financial Officer
18. Title
19. Signature of Financial Director
20. Date
21. Name of Project Director
22. Title
23. Signature of Project Director
24. Date
25. Prepared By
26. E-Mail Address
27. Phone Number
(
)
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