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~~ <br />SAMPLE <br />ATTACHMENT E-1 <br />MONTHLY EXPENSE REPORT <br />Health and WellnessTrust Fund Commission <br />Monthly Expense Report <br />Agency: <br />Contact Person for Expenses: rlwrFC useonly <br />Contact Phone: Approved: <br />Fax: Dale:::' <br />e-math Comments: <br />Federal Tax I D or 501(c)(3): <br /> Y. Year 7 starting on or about 7/1/2004 antl entling 6/30/2006 <br /> 2. Veer 2 starting qn or about 7/7/2005 ahd ending 6/30/2006 <br />iAR ONE Annual eutl eP: Jul >Au usl ' Se !ember October. November Decqmbar rJahbe Febnra ? Maroh i'.A dl :.Ma June '; Veer3o-Dale <br />rect Ez enses: <br />la /VJa eslaenegls 50.00 <br />~nlracletl Staff 50.00 <br />her Please clanf below 50.00 <br />hto(al: 50.00 SO.OD 50.00 50.00 50.00 SO.OD SO.DD 50.00 50.00 SD.OD 50.00 §0.00 50.00 50.00 <br /> <br />her Than Personnel <br />i qrt OTPS <br />Iles/Materiel 50.00 <br />~mmunicatipn Costs <br /> <br />le hone, gsra e, Irei hf §0.00 <br />:cupanty Costs (rent. <br />lines. repairs, <br />rinfenance 50.00 <br />:dla (Advertising and <br /> <br />emotions 50.00 <br />ipilai Outlay (/umi(ure, <br /> <br />ui men!, data recessin ) 50.00 <br /> <br />her Please clan! below §0.00 <br />htolal §0.00 SD.DO 50.00 50.00 50.00 SD,DO 50.00 so.DD §D.DO 50.00 50.00 5000 50.00 50.00 <br /> <br />avel Ez enses <br /> <br />avel (mileage, <br /> <br />ns orta/ton, meats, hotels §O.OD <br />!etln Ex enses 50.00 <br />her Please clan/ below §D.DD <br />iblglai 50.00 §0.00 50.00 50.00 50.00 SO.OD SO OD 5000 50.00 50.00 $000 5000 50.00 SD,OD <br /> <br />M1al Oired Ex enses SO.OD 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 §0,00 50.00 50,00 50.00 <br />direct Costs (only If <br />erred ustlged SD.DD <br />dal Request _. __ SO.DO §0.00 50.00 SO.OD 50.00 50.00 50.00 50.00 50.00 50.00 SOAD 50.00 50.00 SO,OD <br />32 <br />