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EXAMPLE OF COST REPORT <br /> IVA � STATE OF NORTH CAROLINA <br /> d DEPARTMENT OF CRIME CONTROL AND PUBLIC SAFETY <br /> Homeland Security <br /> dr f1 4713 Mail Service Center <br /> Raleigh,NO 27603 <br /> COST REPORT <br /> HOMELAND SECURITY <br /> Vendor NCEM-OPERATIONS EMERGENCY SV CFDA: 97.074 <br /> Contact: Steve Sloan <br /> Address: 4713 Mail Service Center <br /> Raleigh,NC 27699-4713 Request# <br /> Vendor Nbr/Fed ID Nbr 56600000408 <br /> Account Nbr. 4701.-53692010307-1520-030-H1-611 Fund Code; 1520 <br /> OSA Contract Number. RCC; 030 <br /> Grant Period: 7/1/2008-12130/2010 Grant Identifier: HI <br /> MOA*Nbr: 2007-GET-70048-6006 Project Code: 511 <br /> Remarks: <br /> Budget Worksheet TRAINING Tote <br /> Budget Amounts: 0.00 0.00 0.00 0.00 0.00 <br /> Prior Expenditures: 0.00 0.00 0.05 0.00 0.00 <br /> Current Balance: 0.00 0.00 0.00 0.00 <br /> Expended this <br /> period: <br /> Balance Remaining, <br /> Funding Worksheet Amount Pmts to Date Balance %Funding Reimbursement Now Selene <br /> Federal 7 3 --1 100% <br /> State 0.00 0.00 0.00 0% <br /> Match 0.00 0.00 0.00 0% <br /> Subtotal 100% <br /> Fed Admin 0.001 .- 0.01 0. <br /> Total <br /> Certification <br /> I certify the above are correct,based on subgrantees official accounting system and records,consistently applied and maintained,and that expenditures <br /> shown have been made for the purpose of and In accordance with,applicable grant terms and conditions,and that appropriate documentation to support <br /> these costs and expenditures is available or attached. <br /> NCEM-OPERATIONS EMERGENCY SVC Authorized Signature Date <br /> Homeland Security Approval Signature Date <br /> Controller's Office Approval Date <br /> Printed 10/2=010 8:30:54 AM Vendor ID: 1231 <br /> Page 12 of 14 <br />