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r <br /> ATTACHMENT A <br /> 25 <br /> Orange County Government <br /> FY 2010-11 Quarterly Expense Report <br /> Agency: <br /> Quarter Ending: <br /> Reimbursement Instructions <br /> Step 1: For each line item,enter the Grange County program budget and expense amounts for the reporting period.Also explain how <br /> the agency spent Orange County funds during the quarter. <br /> Step 2: Staple a completed cover sheet(see Cover Sheet tab)to the fine item's group of receipts and invoices. Please ensure the <br /> receipt can be matched to the justification description. <br /> (Vote:Verification must be tangible proof(a cashed check,copy of bank statement or credit card receipt or statement)that the agency <br /> paid the receipts and invoices.Each invoice must either show a zero balance,or the vendor must write"Paid in Full,"and date paid, <br /> sign it and print his or her name and title.The invoice must clearly indicate the vendor provided services or merchandise for the <br /> agency. <br /> Step 3:Submit this form and the cover sheet,with stapled invoices and receipts,to Orange County. <br /> Orange County <br /> Description Program Budget Expense Justification <br /> Personnel-Salaries <br /> Personnel-FICA and Fringe <br /> Travel/Mileage <br /> Office Supplies <br /> Program Supplies <br /> Advertising <br /> Rent and Utilities <br /> Miscellaneous <br /> Other Expense <br /> Other Expense <br /> Other Expense <br /> Total Quarterly Expenses p <br /> Expenses During Previous Quarters $ 0 <br /> County Funds Disbursed to Date 0 <br /> Remaining Funds $ 0 <br /> 1 of 3 <br /> Page 25 of 26 <br /> Allocation>=$16,600 <br />