Laserfiche WebLink
<br /> Office of the <br /> Governor Criminal J ustÏce Division <br /> GRANTEE'S REQUEST FOR FUNDS <br /> 1. From: (See Instructions Reverse Side) 2. Grant No. 3. Date of Request 4. Rpquest No. <br /> - <br /> (Name of Grantee) <br /> 5. Grant Title <br /> (Address)- <br /> 6. Grant Period to <br /> (City) (Zip) <br /> 7. Total Grant Award <br /> (Grantee's Telephone Number) <br /> To: Governor's Office <br /> Criminal Justice Division 8. Amount Requested <br /> P. O. Box 12428, Capitol Station <br /> Austin, Texas 78711 <br /> 9. These funds are hereby requested to cover expenditures for the period - <br /> <br /> through as follows: <br /> 10. Criminal Justice Funds received to date: <br /> 11. Less: Actual CJD expenditures to end of month prior to date of this request: <br /> (Do not include local match expenditures) <br /> 12. Subtotal: <br /> <br /> 13. Add: Unpaid request for funds previously submitted: <br /> <br /> 14. Add: Amount of this request for funds: <br /> *(If amount of request includes unusual amount for a non-recurring expense, <br /> attach explanation of nature of expense.) <br /> 15. TOTAL: <br /> 16. Submitted by: <br /> Signature of Financial Officer Title <br /> *Instructions to Grantee: Signature must be effected by the Financial Officer. Grantee shall request funds on a <br /> monthly basis for awards greater than $10,000 and a quarterly basis for awards of $10,000 or less. Non-opera- <br /> tional grants, i.e., equipment purchases, construction and contract services, copies ofinvoices will be submitted <br /> with request for funds. <br /> REQUEST FORMS WITH INCOMPLETE INFORMATION WILL NOT BE HONORED. <br /> To Be Completed by CJ <br /> Administrative Approval: <br /> This request is Approved in the <br /> Amount of $ Special Condition <br /> Initials Initials <br /> Pursuant to authority vested in me, I certify that this Request is correct and proper for payment. <br /> Authorized Certifying Officer Title Date <br /> Rev. Form CJ-3 (12/83) <br />