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<br /> Edward Byrne Memorial State and Local Law Enforcement Assistance Formula Grant Program
<br /> SUMMARY STATEMENT OF QUARTERLY PROJECT COSTS
<br /> (To Be Copied on Jurisdiction Letterhead)
<br />City: Date of Claim:
<br />Proiect Name: Claim Number:
<br />Telephone: Claim Period:
<br />Name of Person Completing Form:
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<br />1. Total Federal Budget $ 2. Amount This Invoice $
<br /> (75% of your current claim)
<br />3. Amount of Previous Invoices $ 4. Remaining Federal Balance $
<br /> (Subtract lines 2 & 3 from line 1)
<br />Sub Object Budget Line Item Exceeds Federal Local Category
<br />Code Categories Disallowed Budget Funds Match Totals
<br /> Salaries &
<br /> Benefits
<br /> Contractual
<br /> Services
<br /> Operating/
<br /> Capital Equipment
<br /> Expenses
<br /> Total Claim
<br />We request payment in accordance with our contract agreement in the amount of 75% of the Total Costs for this
<br />Claim $ (75%), the balance of costs, $ (25%), to be recorded as our in-kind contribution to
<br />comply with the local match requirements.
<br />Attached, please find the records which substantiate the above expenditures. I certify that all of the costs have been paid and
<br />none of the items have been previously reimbursed. All of the expenditures comply with the authorized budget and fall within
<br />the contractual scope of services and all of the goods and services have been received, for which reimbursement is requested.
<br />Respectfully submitted,
<br />Chief of Police/Other City Official Payment Approved, Miami Dade County
<br />
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