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Attachment D <br /> Edward Byrne Memorial Justice Assistance Grant Program <br /> SUMMARY STATEMENT OF QUARTERLY PROJECT COSTS <br /> (To Be Copied on Jurisdiction Letterhead) <br /> • <br /> City: Date of Claim: <br /> Project Name: Claim Number. <br /> Telephone: Claim Period: <br /> Name of Person Completing Form: <br /> t rf •iurK . �'L�S�r .r r'l 4n l .i- pr[ � '•. <br /> 1. Total Federal Budget E 2. Amount This Invoice E <br /> 3. Amount of Previous Invoices S 4. Remaining Budget Balance $ <br /> (wbasu M 2l)Oven W l) <br /> Sub Object Budget Line Item Exceeds Federal Category <br /> Code Categones Disallowed Budget Funds Totals <br /> Salaries 8 <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 100%of the Total Costs for this <br /> Claim$ <br /> Anached.please And the records which substantiate the above expenditures. I certify that al 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 />