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LOCAL HEALTH DEPARTMENT BUDGET 25 <br />N.C. Department of Environment, <br />Health, and Natural Resources Revision Number — <br />Division of General Services <br />SFY Division of Epideraiolm — — — — P. O. Number <br />07 91 // -9? -L -2� 5 2 2 6 0 6 8 <br />Effective Date Termination Date' Contract Number <br />Contractor: Activity: <br />HCFA- Influenza <br />Project Director: Total Budget: $14, %8 <br />Local Authorized Official Signature <br />Finance Officer Signature <br />DEHNR 2948 (Revised 2/90) <br />General Services Division (Review 2/93) <br />Date <br />Date <br />eM"& Had Division /Section Signature <br />Imad <br />Acommunr Fiscal Management Signature <br />W <br />Date <br />Date <br />ITEM DESCRIPTION <br />CLASSIFICATION <br />ITEM AMOUNT <br />E <br />STATE EXPENDITURES: <br />E <br />TXIX /SSBG Fees <br />Other Recei is <br />OTHR REC 103 2,548 <br />X <br />Salaries & Fringe Benefits <br />SA/FR <br />1000 12,0W <br />STATE/FEDERAL /SPECIAL FUNDS: <br />Operating Expenses <br />I <br />OP EXP <br />2000 <br />P <br />Purchase of Equipment <br />E LJIP <br />- <br />5000 <br />E <br />General Contracted or <br />S <br />N <br />Purchased Services <br />Subtotal State/Federal/Special $ 12,000 <br />GE R ..:.. ,;:" <br />06 :. . <br />School Health <br />$1'HLTH. <br />D <br />Clinician <br />6$C3 <br />T <br />Laboratory <br />h <br />Parma Services <br />SER <br />U <br />Transfer TXIX <br />R <br />Subtotal State Expend. <br />$ 12,000 <br />E <br />LOCAL EXPENDITURES: <br />LOCAL EXP <br />9000 2 >548 <br />S <br />TOTAL EXPENDITURES — equal to Total Receipts <br />$14,548 <br />Local Authorized Official Signature <br />Finance Officer Signature <br />DEHNR 2948 (Revised 2/90) <br />General Services Division (Review 2/93) <br />Date <br />Date <br />eM"& Had Division /Section Signature <br />Imad <br />Acommunr Fiscal Management Signature <br />W <br />Date <br />Date <br />LOCAL FUNDS: <br />R <br />Appropriation <br />APPROP 101 0 <br />TXIX /SSBG 102 Q <br />E <br />TXIX /SSBG Fees <br />Other Recei is <br />OTHR REC 103 2,548 <br />C <br />Subtotal Local Funds $ 2,5Q <br />E <br />STATE/FEDERAL /SPECIAL FUNDS: <br />I <br />P <br />T <br />S <br />Subtotal State/Federal/Special $ 12,000 <br />TOTAL RECEIPTS — equal to Total Expenditures $ 14,548 <br />Local Authorized Official Signature <br />Finance Officer Signature <br />DEHNR 2948 (Revised 2/90) <br />General Services Division (Review 2/93) <br />Date <br />Date <br />eM"& Had Division /Section Signature <br />Imad <br />Acommunr Fiscal Management Signature <br />W <br />Date <br />Date <br />