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4 <br /> LOCAL HEALTH DEPARTMENT BUDGET <br /> N C. Department of Environment, <br /> Health, and Natural Resources Revision Number—— <br /> Division of General Services <br /> SFy Division of Maternal and Child Health ————P. O. Number <br /> July 1 / 1994 June 30 / 1995 9 5 5 3 5 9 0 <br /> Effective Date Termination Date Contract Number <br /> 1 <br /> Orange County Health Department EPSDT Outreach Project <br /> Contractor: Activity: <br /> Daniel Reimer 10,000 <br /> Project Director: Total Budget: $ <br /> ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT <br /> E STATE EXPENDITURES: <br /> X Salaries & Fringe Benefits SA/FR 1000 10,00n <br /> Operating Expenses OP EXP 2000 <br /> P Purchase of Equipment EQUIP 5000 <br /> E General Contracted or <br /> N Purchased Services GENERAL 6100 <br /> School Health IS+C.H:IiLTH =:'':6200 <br /> D Clinician CLN 6863 <br /> I <br /> T Laboratory LAB 6862 <br /> Pharmacy Services RX SERV 6865 <br /> Transfer TX <br /> U IX <br /> R Subtotal State Expend. $ 10,000 <br /> E LOCAL EXPENDITURES: LOCAL EXP 9000 <br /> S TOTAL EXPENDITURES—equal to Total Receipts $ 10,000 <br /> LOCAL FUNDS: <br /> R Appropriation APPROP 101 <br /> E TXIX TXIX 102 <br /> Other Receipts OTHR REC 103 <br /> C <br /> E Subtotal Local Funds $ <br /> STATE/FEDERAL/SPECIAL FUNDS: <br /> I <br /> 10,000 <br /> P <br /> T <br /> S <br /> Subtotal State/Federal/S cial $ <br /> TOTAL RECEIPTS—equal to Total Expenditures $ 10,000 <br /> Local Authorized Official Signature Date Branch Head Division/Section Signature Date <br /> [ninal <br /> Finance Officer Signature Date Accountant Fiscal Management Signature Date <br /> lmoal <br /> DM NR 2948(Revised 2/93) <br /> General Services Division(Review 2/94) <br />