NYS Education Department
NYS Education Department Interim Project
89 Washington Avenue Expenditure Report
Room 136 EB SLP-25 (11/14)
Albany, NY 12234
Contract No. ________________
Agency Name: ________________________________________________
Expenditures Reported During The Period (Indicate the time period covered by the reported expenditures in the following spaces):
From:_______________ To: _________________
Activity Expenditure Amount *
Salaries for Staff $_________________________
Purchased Services $_________________________
Supplies and Materials $_________________________
Travel Expenses $_________________________
Employee Benefits $_________________________
Indirect Cost - Overhead $_________________________
Minor Remodeling $_________________________
Equipment $_________________________
Total $_____________________
_______________________________ __________________________
Signature of Chief Financial Officer Date
_______________________________ __________________________
Title Telephone No.
*Do Not Duplicate Previous Expenditure Reports
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