COUNTY OF NORTHAMPTON GAMING REVENUE AND ECONOMIC REDEVELOPMENT AUTHORITY NORTHAMPTON COUNTY COURTHOUSE 669 WASHINGTON STREET EASTON, PENNSYLVANIA 18042-7492 Phone: (610) 559-3200 Alicia M. Karner Fax: (610) 559-3775 Executive Director To: 2010 Local Share Municipal Gaming Grantees From: Northampton County Gaming Revenue & Economic Redevelopment Authority Alicia M. Karner, Executive Director Date: June 2, 2011 Re: 2010 Local Share Municipal Gaming Grant Mid-Year Report As stated in the 2010 Local Share Municipal Gaming Grant Contract, the Municipality shall submit periodic reports to the Authority at least every six (6) months which shall contain all necessary supporting documentation to enable the Northampton County Gaming Revenue & Economic Redevelopment Authority to determine whether the Municipality’s use of the grant proceeds complied with the application, the project budget and the grant agreement. Please complete the attached mid-year report form in its entirety and return to the address listed below, by June 30, 2011. A fill-in form is available on the gaming webpage, found in the DCED section of Northampton County’s website: www.northamptoncounty.org. Northampton County Gaming Revenue & Economic Redevelopment Authority Attn: Alicia M. Karner, Executive Director 669 Washington Street Easton, PA 18042 If you have any questions please feel free to contact me at (610) 559-3200, Option 3. Local Share Municipal Gaming Grant Mid-Year Report Municipality Name: Grant Amount: Project Name: Address: Phone: Email: Instructions: Indicate the amount of grant funds spent and the remaining amount of grant funds, to date, for project costs in each category. Please be sure that funds are spent in accordance with the project budget in the original grant application. Submit all copies of invoices, cancelled checks and receipts relating to the project, identified with the appropriate number from each line item. For example: The grant award was $10,000 for the purchase of new equipment. $6,000 of the grant award was spent to date. In the row, number 22, for New Equipment Purchase, under the Grant Funds Spent column, list $6,000. In the Remaining Grant Funds column, list $4,000. On all documentation relating to the expenditures, write the line item number 22 on each invoice, cancelled check or receipt submitted. Line PROJECT COSTS GRANT FUNDS REMAINING GRANT Item SPENT FUNDS ACQUISITION 1 Land $ $ 2 Buildings $ $ Subtotal $ $ INFRASTRUCTURE/SITE PREPARATION 3 Roads & Streets $ $ 4 Parking $ $ 5 Water/Sewer $ $ 6 Utilities $ $ 7 Demolition $ $ 8 Excavation/Grading $ $ 9 Environmental Cleanup $ $ Subtotal $ $ Line PROJECT COSTS GRANT FUNDS REMAINING GRANT Item SPENT FUNDS OPERATING COSTS/ WORKING CAPITAL 10 Working Capital $ $ 11 Salaries & Fringe Benefits $ $ 12 Training & Technical Assistance $ $ 13 Consumable Supplies $ $ 14 Travel $ $ 15 Promotion/Public $ $ Relations/Advertising 16 Office Equipment $ $ 17 Space Costs $ $ 18 Audit $ $ 19 Indirect Costs $ $ Subtotal $ $ GENERAL CONSTRUCTION 20 New Construction $ $ 21 Renovations $ $ Subtotal $ $ MACHINERY & EQUIPMENT 22 New Equipment Purchase $ $ 23 Used Equipment $ $ Purchase 24 Upgrade Existing $ $ 25 Installation/Building $ $ Modification 26 Vehicles $ $ Subtotal $ $ OTHER COSTS 27 Professional Services/ $ $ Consultants 28 Engineering $ $ 29 Inspections $ $ Line PROJECT COSTS GRANT FUNDS REMAINING GRANT Item SPENT FUNDS 30 Fees $ $ 31 Insurance $ $ 32 Environmental Assessment $ $ 33 Legal Costs $ $ 34 Closing Costs $ $ 35 Contingencies $ $ 36 Subtotal $ $ 37 Miscellaneous $ $ Subtotal $ $ TOTAL $ $ Mail the completed form to Northampton County Gaming Revenue & Economic Redevelopment Authority, Attn: Alicia M. Karner, 669 Washington Street, Easton, PA 18042.
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