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["DCJS-3263 (2020)"]
["NYS Division of Criminal Justice Services"]
["Detailed Itemization of Non-Personal Expenditures"]
["Alterations"]
[]
["1. Grantee Name:                                          "]
["2. Contract Number:"]
["3. DCJS Number:"]
["4. Report Period:                                            From:",{"$nulls":3},"To:"]
["5. Contract Period:                                         From:",{"$nulls":3},"To:"]
[]
["This form is used to certify the expenditures claimed for Alterations. The amounts charged to the grant for Alteration expenditures must be valid expenses per Appendix B of the contract. All Alteration expenses must have an appropriate and reasonable basis for allocating the expenses for this project."]
[]
[{"$nulls":7},"Amount Charged to"]
["6a","6b","6c","6d","6e","6f",null,"6g","6h"]
["Check Number/Payment Method","Expense Date","Payee","Property Address","Description","Vendor Type",null,"Grant Funds","Match"]
[]
[]
[]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[{"$nulls":5},"MBE"]
[{"$nulls":5},"WBE"]
[{"$nulls":5},"Other"]
[]
["Totals should be carried forward to Category H, Column C of the Fiscal Cost Report",{"$nulls":5},"6i Total:",{"$f":"IF(SUM(H20:H76)=0,\"\",SUM(H20:H76))","v":""},{"$f":"IF(SUM(I20:I76)=0,\"\",SUM(I20:I76))","v":""}]
[]
["Certification:",null,"I certify that the above expenditures were made in accordance with the pertinent grant, are appropriate to the goals and objectives of the project described therein, and are not duplicative of expenditures claimed on any other grants."]
[]
[]
["Signature:",{"$nulls":3},"Print Name:"]
[]
["Title:",{"$nulls":3},"Date:"]