Grant Expenditure Report Indiana Recycling And HHW Grant Programs {51986}

Office of Pollution Prevention and Technical Assistance RECYCLING & HHW GRANT PROGRAM Grant Expenditure Report 402 West Washington Street, W041 P.O. Box 7095 Indiana Recycling & HHW Grant Programs Indianapolis, IN 46207-7095 State Form 51986 (11-04) Indiana Department of Environmental Management Internet: http://www.in.gov/idem/resources/ grants_loans/recycling/ INSTRUCTIONS: Call your grant representative for assistance with this report. Use one sheet for each grant budget category. Designate a category to each sheet. For PEP grants budget categories are Print Material (brochures, copying, publications, printing costs, etc.), Signage (billboard, informational signage, etc.), Advertising (TV/Cable, Radio, Newspaper), Promotional Education Items, or Other (conferences/training, performers, subscriptions, booth rental, books, videos, etc.). SECTION 1 Name of Grantee: Action Review Number (ARN): GRANT INFORMATION Grant Amount: Grant State Date: $ Grant End Date: SECTION 2 Budget Category: Invoice Date Vendor BUDGET CATEGORY EXPENDITURES Total Expense Amount Description of expense or match Check Number Grant Amount Cash Match Amount In-kind Amount Subtotal: TOTAL: Total Match: American LegalNet, Inc. www.FormsWorkflow.com s