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LOCAL HEALTH DEPARyff ff�ET <br />�1.CDepartment . Depar of Environment, `` ��// <br />- Health, and Natural Resources �� h Revision Number -D— L <br />Division of General Services 5 . <br />SFY Division of E A 1" <br />�•lly� 4 � I P.O. -Number <br />' <br />07 /91 / 9 2 0 6 8 <br />Effective Date Termination Date ^ — <br />�'1/ Conn tract Number <br />Contractor: Oramcfe County HealLh �'Activity: Tuberculosis <br />Project Director: Total Budget: $?5.3`__ <br />E <br />X <br />P <br />E <br />N <br />D <br />I <br />T <br />U <br />R <br />E <br />S <br />ITEM DESCRIPTION <br />STATE EXPENDITURES: <br />Salaries & Fringe Benefits <br />Operating Expenses <br />Purchase of Equipment <br />General Contracted or <br />Purchased Services <br />School Health <br />Clinician <br />Laboratory <br />Pharmacy Services <br />Transfer TXIX <br />Subtotal State <br />CLASSIFICATION ITEM <br />SA/FR 1000 <br />OP EXP 2000 <br />E !:2 5000 <br />GENERAL 6100 <br />CLN 6863 <br />LA.B 6862 <br />RX SERV 6865 <br />LOCAL EXPENDITURES: I LOCAL EXP 9000 <br />TOTAL EXPENDITURES — equal to Total Receipts <br />AMOUNT <br />$ 353 <br />Inina Divisi Section Signatur Date <br />Finance Officer Signature Date <br />/ a e m Signature Date <br />DEHNR 2948 (Revised 2/90) �- <br />General Services Division (Review 2/93) <br />qz I <br />I <br />Local Authorized Official Signa D <br />Date b <br />branch - <br />- <br />