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LOCAL HEALTH DEPARp ff W ET <br />N.C. Department of Environment, <br />-Health, and Natural Resources j ' '^ ^�� - Revisio Number /L /L <br />Division of General Services <br />Division of E i � <br />5FY P. O: Number <br />07 /91 06 /� 92 9 2 �5 ----2 --? -° 0 6 8 <br />Effective Date Termination Date _ v Contract Number <br />Contractor: Orange County Health Pent , �Activity: Tuberculosis <br />Project Director: 1 =1e1 - B. Reimer _ —_ Total Budget: $ T-;'� —• -- <br />TOTAL EXPENDITURES -- equal to Total Receipts <br />ITEM DESCRIPTION <br />CLASSIFICATION <br />ITEM AMOUNT <br />E <br />STATE EXPENDITURES: <br />101 <br />E <br />TX1X /SSBG Fees <br />Other Receipts <br />X <br />Salaries & Fringe Benefits <br />OTHR REC <br />SA/FR <br />1000 <br />Operating Expenses <br />OP EXP <br />2000 <br />P <br />Purchase of Equipment <br />E UIP <br />5000 <br />E <br />General Contracted or <br />N <br />Purchased Services <br />GENERAL <br />6100 <br />School Health <br />H.T#L <br />Clinician <br />CLN <br />6863 <br />$ 353 <br />TOTAL RECEIPTS -- equal to Total Expenditures <br />_ <br />$ <br />Laboratory ry <br />LAB <br />6862 <br />Pharmacy Services <br />RX SERV <br />6865 <br />U <br />Transfer T= <br />R <br />Subtotal State E d. <br />$ 353 <br />E <br />LOCAL EXPENDITURES: <br />LOCAL EXP <br />9000 <br />TOTAL EXPENDITURES -- equal to Total Receipts <br />0� L <br />thorized Official <br />Signature <br />DEHNR 2948 (Revised 2/90) <br />General Services Division (Review 2/93) <br />Date <br />Division SectYan Signatur Date <br />Date Amt e nt Signature <br />�l <br />7 - /1- <br />Date <br />LOCAL FUNDS: <br />R <br />Appropriation <br />APPROP <br />101 <br />E <br />TX1X /SSBG Fees <br />Other Receipts <br />TX1X /SSBG <br />102 <br />OTHR REC <br />103 <br />C <br />E <br />Subtotal Local Funds <br />$ <br />STATE /FEDERAL /SPECIAL FUNDS: <br />I <br />T <br />S <br />Subtotal %te/Federal /S <br />$ 353 <br />TOTAL RECEIPTS -- equal to Total Expenditures <br />_ <br />$ <br />0� L <br />thorized Official <br />Signature <br />DEHNR 2948 (Revised 2/90) <br />General Services Division (Review 2/93) <br />Date <br />Division SectYan Signatur Date <br />Date Amt e nt Signature <br />�l <br />7 - /1- <br />Date <br />