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<br />SANfPLE <br />ATTACHMENT E-1 <br />MONTHLY EXPENSE REPORT <br />Health and WellnessTrust Fund Commission <br />Monthly Expense Report <br />AstencY: <br />Contact Person for Expenses: rivyTFC iJse ~Jnty ; <br />Contact Phone: Appm~ed; <br />Fax: Date <br />e-mail commems <br />Federal Tax LD. or 501(c)(3): <br />1. Year 7 starting on orabout 7H/2004 and ending 6/30/2005 <br />2. Year 2 starting on or about 7/7/2005 ahd ending 8/30/2006 <br />AR ONE n t `. .Jul '. Au T S tember -Dctober ven ber December Jenua Feb rue March. nl fd June Year-To-Oate <br />•ect Ex enses• <br />la /Wa esBenefits $0.00 <br />ntracted Staff $0.00 <br />ier Please cla ' below $0.00 <br />btotal• $0.00 SD.OD 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 gn on <br /> <br />ner Than Personnel <br />ort OTPS <br />IiesRUlaterial $0.00 <br />mmunication Costs <br />le hone, sta e, fiei ht <br />$0.00 <br />cupancy Costs (rent, <br />ifies, repairs, <br />iintenance <br /> <br />$0.00 <br />~dia (Advertising and <br />emotions <br />$0.00 <br />pital Outlay (furniture, <br />~i menf data rocessin <br />$0.00 <br />ier Please clan below $0.00 <br />btotal $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 <br /> <br />rvel Ex enses <br />rvel (mileage, <br />ns Ration, meals, hotels <br />$0.00 <br />~etin enses $0.00 <br />ier Please clan below $0.00 <br />btotal $0.00 $O.DO $0.00 80.00 $0.00 SO.DO $0.00 50.00 $0:00 50.00 $0.00 $0.00 $0.00 $0.00 <br /> <br />tal Direct Ex enses 50.00 50.00 $D.DD 50.00 $0.00 50.00 $0.00 $0.00 $O.OD 50.00 $0.00 $D.OD $D.00 SO.Du <br />lirect Costs (onty if <br />erred ustified <br />$0.00 <br />tal RecLuest $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 <br />32 <br />