CRF Claim by undul850

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									                                                CONSOLIDATED REVENUE FUND (CRF)
                                                     PAYMENT CLAIM FORM

        ORGANIZATION INFORMATION                                                            (CRF)
       Organization:
                                                                                                                                                                                HRSDC USE ONLY

       Current Mailing Address:                                                                                                                                             Receipt Date:


       City/Town:                                                         Province:                                                          Postal Code:                   RC #:


       Telephone:                                                         Fax:                                                                                              File #:


       Has the address changed since the last claim to HRSDC? Period Covered by this Claim
                                                                                                                                                                            Is this a final claim?
                    Yes        No                                         From:                                         To:                                                  Yes        No


        EXPENDITURES
       Type Of Expenditure                                                                                                HRSDC USE ONLY
                                                Claimed this Period
                                                 (to nearest dollar)                                    Amounts Eligible This Claim                                              Amounts Allowed

       PROGRAM ADMINSTRATION                                                  Interest/Revenue                 Carry Forward                     Current Period                     Year to date


       General Operating Costs


          - Salary & benefits


          - Non-salary operating


          - Capital

                      Program Administration
                                                                      -   $                         -     $                              -   $                          -   $                              -
                                  Sub-Total

       Capacity Building


               Program Administration Total
                                                                  -       $                     -          $                         -       $                      -       $                          -

       PROGRAM ASSISTANCE


       Part I: Labour Market Programs


       • Section III Other Programs


       Part II: Youth

               Program Assistance Total                               -   $                         -      $                             -   $                          -   $                              -

       First Nations/Inuit Child Care                    #REF!

        CRF Total for Claim Period                       #REF!            $                 -              $                     -           $                  -            $                     -
       Employment Assistance Services
                                                         #REF!
       (inc. in Part I and/or Part II above)




        REVENUE/INTEREST & GST/HST
       Revenue earned through project activities:                                                                       Directed to:
                                                                                      $

                                                                                      $

                                                                                      $
       Interest earned during the period of this claim: Interest on Chequing                                            Directed to: Programs
       Account




                                                                                                                                             50% x          Other _____%
       Percentage of GST/HST the organization is entitled to receive from Canada Revenue Agency.




        CERTIFICATION

       I (we) certify that the information is true and correct to the best of my knowledge and claimed in accordance with the agreement.


       Supporting Documentation Attached: Yes                x
                                                             No                                           Client Data Upload Sent Yes                 No
       Comments:




       Signature:                                                                                         Signature:                                    Date:


       Print Name:                                                                                        Print Name:                                   Position Title:




        FINANCIAL CODING
       Allot          Resp          Activity   Project                    Amount                                              (+/-)          CMS TYPE   SUPPLEMENTARY
                      Centre




       Cheque Stub Information:                                                                                                                         Final Payment
                                                                                                                                                        Yes       No


Revised Dec. 2005                                                                     CRF Claim                                                                                   Finance Appendix #1 - A
                                         CONSOLIDATED REVENUE FUND (CRF)
                                              PAYMENT CLAIM FORM


        CLAIM VERIFICATION
       Expenditure Verified Signature:                                              The Pre-Audit has been performed and is
                                                                                    Accurate. Financial Management Services

       Name(print)                                                                  Signature


       Position Title:                                                              Name (Print):


                                                                                    Position Title:                Date:

       Date:
       System Approval                                       Posted to CMS (Please place Stamp imprint here, date and initial)


       Initials:




       Date:




Revised Dec. 2005                                    CRF Claim                                                   Finance Appendix #1 - A

								
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