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MAY 26 .e i,i•
<br /> LOCAL HEALTH DEPARTMENT Bea y s2�
<br /> N.C.Department of Human Resources qp_ Revision Number___
<br /> Division of Health Services Maternal and Child Care ,,4.; N% _
<br /> SPY Office,Section or Branch •g AY198g
<br /> M: P.O.Number
<br /> •07/ 89 • 06 / 90 �,'�,\ %(1 . 4 _6. �,.II_...Q� (:'.2
<br /> Effective Date Tertrunation Date 'i „��{ ,s} ,� Contract Number
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<br /> Contractor. Orange County Health_Department Activity: Ni tri ti nn Ti t7 e. xy
<br /> Project Director: Daniel B. Reimer Total Budget:$ 2,119.50 (150 x $14..13)
<br /> ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
<br /> STATE EXPENDITURES: £ / ..P�✓ 3, x ,. ,�� , s
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<br /> �• y°4 fitig gi*”rs .t`�,>r�'Fyi3it P ,sY #�# z r ra . a,
<br /> X Salaries St Fringe Benefits ¢ ..),:«s° .-q i • 4 3 u 4`f�/°c I$ ,:a`rAekt sd s1,•At a: A
<br /> tO0 � , ue, -p w w �a 9» r
<br /> •a3 y.ffa L�••
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<br /> perating k s Y [ ., +.. C.s :3 E3c;.
<br /> p Purchase of Equipment � _ t 4�4,q u C 4 � :; .
<br /> c; fs s K a > r, � y > r' s'
<br /> E , General Contracted or l � rt* 4 :t. :. 7 ,; g�� 4;&;. ,
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<br /> kr s ` s ' S k a A .: .' rA•yePurchased Services in5 ,s' rav'k...t rf t, � g �" ' '? ' ¢N School Health ."'�.y» .n � ',:. f P„ � X > s. ..::. : . .•Y� Md ! ? Sk L .* s 4 3 1M�ro : i j?
<br /> Ci[ir � 1 .. ..mt. ^s" '-
<br /> ilr 99 < F *41- .4/9 b /*.c. $OAt. el,3 �•:v
<br /> ,—.> . r-- r zt c f < < s t4.tc $ wt'.. "f1-4. a:,.'raY:ro.s
<br /> I Delivery Services � k us: w p r° h vx � ��r •F Y 4 .•,� '~;
<br /> Laboratory c M M ; ;P �s�° °;a
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<br /> r h , k, , ,Parmacy Services y
<br /> tI Transfer '1XDC/S58G r mse .NJk s : N i , A' ' ...w. �' $,e .P P k Z9 ' - . -
<br /> E. Subtotal State Expend. $
<br /> E LOCAL EXPENDITURES: _ LOCAL EXP 9000 (150 x 14.13) 2,119.50
<br /> S TOTAL EXPENDITURES—equal to Total Receipts $ 2,119.50
<br /> P; LOCAL FUNDS:
<br /> Appropriation APPROP 101 (I0 x 368) _513.2.00
<br /> E TXIx/SSBG Fees 102 (150 x 10.20 14337.50
<br /> C Other Receipts OTHR REC— 103
<br /> E , Subtotal Local Funds _ (101 + 102) $ 2,119.50
<br /> 1 STATE/FEDERAL/SPECIAL FUNDS:
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<br /> Subtotal State/Federal/Special $
<br /> TOTAL RECEIPTS—equal to Total Expenditures $ 2,119.50
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<br /> Lill • %.i4.di _6/3a i 8411 �,�� ��>n r w`' ,
<br /> . Authorized Official S'_a -- a to s Had DHS Section Chief Sig ture Date
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<br /> D Lrii 441 /, ,..,_�.
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<br /> o Fiance Officer Signature s DHS s' cer Si gna ture
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<br /> DHS 2948(Revised 2/87)
<br /> Contracts Administration(Review 2/90)
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