Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $80,671.46 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 1408001 Hood River SD Business Manager 0000 Xxxxxx Xxxxxx Hood River, OR 97031 National School Lunch Program State Revenue Matching
Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $39,382.29 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 0519003 St. Helens SD 502 Business Manager 000 X 00xx Xx. St. Helens, OR 97051 National School Lunch Program State Revenue Matching
Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $3,193.28 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 1207001 John Day SD 3 Business Manager 000 X. Xxxxxx Xxxx Xxxx. Canyon City, OR 97820 National School Lunch Program State Revenue Matching
Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $3,551.13 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2613008 Multnomah ESD Business Manager PO Box 301039 Portland, OR 97294 National School Lunch Program State Revenue Matching
Reporting Form. 3 – Local Cost Share Certification in accordance with Table below. • A copy of the current and accurate Local Budget (General Revenue) including the signed budget in accordance with Table below. • A copy of the Emergency Management general revenue expenditure (general ledger) report in accordance with Table below. REPORTING REQUIREMENTS: Quarter 1 Quarter 2 Quarter 3 Quarter 4 N/A Deliverables Due Updates Only Updates Only TASK 3: RESPONSE CAPABILITIES
Reporting Form. The following report is due on or before March 1 of each year (commencing with March 1, 2016) in connection with the Data License and Service Agreement between Rovi and CUR Media, Inc. Capitalized terms in this report will have the definitions given to those terms in such agreement. Licensee Property covered by this report: The Website and the Application · Please attach all data and reports used to complete this form (including reports from Web Analytics Providers). · Please list the number of Subscribers for the above listed Licensee Property during the three (3) months indicated below as well as the average number of Subscribers for those months: Year Total Subscribers of Licensee Property December January
Reporting Form. Tax return forms will be furnished at no charge to each licensee at least 30 days prior to the due date of the return. Failure to receive the authorized return form does not relieve the licensee from the obligation of submitting a return. The licensee may submit a written or computer generated tax return in lieu of the standard tax return if the return includes all of the information required by this Agreement and is in a form acceptable to the base jurisdiction. The licensee shall file a tax return for the tax reporting period with the base jurisdiction and shall pay all taxes due to all member jurisdictions with the remittance payable to the base jurisdiction by the due date. This payment must be included with the return. A base jurisdiction may authorize a licensee to submit a tax return electronically, in lieu of the standard tax return if the return includes all the information required by this Agreement and is in a form acceptable to the base jurisdiction.
Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $3,138.73 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2301002 Annex SD 29 Business Manager 000 Xxxxx Xxxx Ontario, OR 97914 National School Lunch Program State Revenue Matching
Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,779.80 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2704001 Dallas SD Business Manager 000 XX Xxx St Dallas, OR 97338 National School Lunch Program State Revenue Matching
Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $3,939.56 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 1204001 Dayville SD 16J Business Manager P.O. Box C Dayville, OR 97825 National School Lunch Program State Revenue Matching
