Apbc Financial Report Form - State Of Alaska Department Of Administration printable pdf download

Apbc Financial Report Form - State Of Alaska Department Of Administration

Department of Administration

State of Alaska

Division of Administrative Services

Department of Administration

P.O. Box 110208,

Juneau, AK 99811-0208

APBC Financial Report

Phone (907) 465-5647

Fax

(907) 465-2194

rev. 8/1/97

Grantee Name and Address

Grant Number:

Grant Name

! Yes

! No

Final Report

Report for the period:

! July – September

! January - March

! October – December

! April - June

! Other From ____________ to ___________

Remarks

TATE

RANT

XPENDITURE

ISTORY

A) Total Grant Amount

B) Previously reported

expenditures

C) Expenditures this period

D) Total Expenditures

E) State Payments to Date

I certify that to the best of my knowledge and belief, the data reported herein is correct and all outlays were made in accordance with grant

conditions and the payment is due and has not been previously requested.

Signature of authorized official

Printed Name

Title

Date

Telephone

Fax

E-mail address

FOR STATE USE ONLY

PVN

Batch

Encumbrance

! First advance

! Third advance

Payment Amount

! Second Advance

! Final advance

Approved for payment

NOTE: Make sure this financial report is attached to a balance sheet and revenue/expenditure report. The end date of those

reports should match the end date of this report. A final report is not submitted until all state funds are expended.

PLEASE COMPLETE BOTH SIDES OF THIS FORM

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Apbc Financial Report Form - State Of Alaska Department Of Administration

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