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: $1,574.96 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 0201001 Alsea SD 7J Business Manager PO Box B Alsea, OR 97324 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. 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: $26,197.90 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2207001 Greater Albany SD 8J Business Manager 0000 Xxxxx Xxxxxxx Xx XX Xxxxxx, XX 00000 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: $3,384.56 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 3402002 Beaverton SD 48J Business Manager 00000 XX Xxxxxx Xxxx Suite 1400 Hillsboro, OR 97006 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: $9,902.28 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2604001 Xxxxx Xxxxxxx SD 40 Business Manager 2900 SE 122nd Portland, OR 97236 National School Lunch Program State Revenue Matching
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. This form can be found in the forms section of the Applicant Manual or downloaded from the NDE website at xxx.xxx.xxxxx.xx.xx click on Teacher Certification. Is an order or determination currently in effect by a court or any other governmental body which finds you to be any of the following: a mentally ill and dangerous person; mentally incompetent to stand trial; acquitted of criminal charges because of insanity; an incapacitated person in need of a guardian; or unable to manage your property due to mental illness, mental deficiency, chronic use of drugs or chronic intoxication? If you answer yes, attach a copy of the order and a written statement that fully explains the facts and where this occurred. Are you currently an inpatient or resident in a mental health facility due to a determination by a qualified mental health professional? If you answer yes, please attach a written statement that fully explains the facts and where this is occurring. Are you a US Citizen? If no, complete the United States Citizenship Attestation Form.
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. The following report is due on or before March 15 of each year (commencing with March 15, 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 February Average of these 3 months: As a reminder, your fee schedule for License Fees for Initial Term Period Two and the Extended Term is shown below. Payment Period Monthly License Fee Initial Term Period Two (3/15/2016 – 3/14/2017) During Initial Term Period Two and each Extended Term, the Monthly License Fee shall be based on the average number of Subscribers of the Licensee Property during the months of December, January and February immediately preceding Initial Term Year Two or such Extended Term, as the case may be, according to the following chart (the “Total Monthly License Fee”): Average number of Subscribers Rovi Content Monthly License Fee: Search, Recommendations & Conversation Monthly License Fee: Total Monthly License Fee: 0 – 250,000 $*** $*** $*** 250,001 – 1,000,000 $*** $*** $*** 1,000,001 – 2,000,000 $*** $*** $*** 2,000,001 – 3,000,000 $*** $*** $*** 3,000,001 – 4,000,000 $*** $*** $*** More than 4,000,000 $*** $*** $*** Extended Term On the first date of each Extended Term (commencing with the second Extended Term) (each such date, a “Rate Increase Date”), each Monthly License Fee set forth in the table above shall be increased by a percentage equal to the greater of (x) the annual percentage increase in the Consumer Price Index for All Urban Consumers (CPI-U) for the U.S. City Average for “All Items” during the twelve month period immediately preceding such Rate Increase Date, and (y) 3%. CUR MEDIA, INC. By: Name: Title: Submission Instructions: Please scan and e-mail this report to rxxxxxx@xxxxxxxx.xxx Appendix 3 Service Level Agreement This Service Level Agreement ("SLA") shall apply only to the Work Product described in Appendix 2 to the Data License and Service Agreement, dated July 1, 2014 between CUR Media, Inc. and Rov...
Reporting Form. The appropriate Federal Income Tax reporting form, if any. Authorizing Resolution. A resolution of Seller authorizing the conveyance of the Property. Minnesota Well Certificate. If necessary, a well certificate conforming to Minnesota law.
