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N.C. Dcgartraent of Environment, _ <br />Health, and Natural Resources / <br />Division of General Services ` <br />SFY n h <br />Divi-sion of Maternal and Child Health <br />�' -,� / 91 / -) <br />Effective Date Termination Date <br />Revision Number <br />P. O. Numbe <br />9 2 5 1 �7 0 6 8 <br />Conrract Number <br />Contractor: _ �t . Acdviry: �ICC Grant <br />Project Director: i R R Total Budget: $ 8,750 <br />E <br />x <br />P <br />E <br />N <br />D <br />Z <br />T <br />U <br />f -�E <br />FI S <br />R <br />E <br />C <br />E <br />Y <br />P <br />T <br />S <br />ITEM DESCB PTION <br />STATE EXPENDTTf MES: <br />Salaries 6L Fringe Benefits <br />Operating Expcnscs <br />Purchase of EQuipment <br />General Contracted or . <br />Purchased Services <br />School Health <br />Clinician <br />Delivery Services <br />Laboratory <br />Pharmacy Services <br />Transfer TXIX <br />Subtotal State <br />LOCAL EXPENDITURES: <br />CLASSIFICATION ITEM <br />AMOUNT <br />SA/FR 1000 8.750 <br />OP EXP 2000 <br />LC>C LT- EXP 9000 <br />TOTAL EXPENDI1i7RES — eon to Total Receipts <br />L-1-A- -L rUNDS: <br />Appropriation <br />TXD /SSBG Fees <br />Other Receinm <br />Subtotal Laval Funds <br />S T A w/PEDERAL /SPECIA.L FLYNDS: <br />och7 � <br />Subtotal <br />e <br />APPROP <br />101 <br />TXIX /SSBG <br />lOZ <br />OTHR REC <br />103 <br />151t) - &-too -;51,o 7 <br />TOTAL RECE¢ — eaual to Total Expenditures <br />S <br />�� <br />Laval Authorized Official Si , e 3 q <br />.T <br />Date s,��� Division/ �crion Signaruty Date <br />G z /� <br />rinamcc Oiricer signature %� Y <br />Date <br />4 -Signa, are <br />D ,TR 2948 (Rmis d Z /90) <br />G si�l 5-vic= I3j won (Review 2/91) <br />