Emergency Shelter Grant Funding - Close Out Report Reporting Period: 07/01/09 – 06/30/10 NAME OF GRANTEE: DATE: CONTRACT ENCUMBRANCE NUMBER: H0ESG09 FUNDING SOURCES: ESG: OTHER FEDERAL: LOCAL GOVERNMENT: PRIVATE: FEES: OTHER: TOTAL: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 SOURCES OF LOCAL MATCH/BREAKDOWN OF FUNDING: OTHER FEDERAL: (Including pass-through funds, e.g. City CDBG, County FEMA, etc.) $0.00 $0.00 $0.00 $0.00 $0.00 STATE/LOCAL GOVERNMENT FUNDING: (e.g. State Housing Trust Funds, Local Assessment, etc.) $0.00 $0.00 $0.00 $0.00 $0.00 PRIVATE (including recipient) FUNDING: Fund Raising/Cash Loans Building Value or Lease Donated Goods Donated Computers New Staff Salaries Volunteers ($5/hr) Volunteer Medical/Legal $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FUNDING CLOSE – OUT FORM INSTRUCTION GRANTEE NAME: This is where your shelter’s name goes. CONTRACT ENCUMBRACE NUMBER: This is the same number used on your quarterly reports for the 2008-2009 Emergency Shelter Grant year. EMERGENCY SHELTER GRANT: You need to enter your shelters Emergency Shelter Grant TOTAL AWARD amount for the 2008-2009 Emergency Shelter Grant year. FUNDING SOURCE: This is where you report your shelters Emergency Shelter Grant MATCH SOURCE AMOUNT. ****Remember to only report your ESG match only****** TOTAL: This is the TOTAL of your Emergency Shelter Grant amount for the 2008-2009 year and your Match Source amount. SOURCE OF FEDERAL, STATE, AND LOCAL MATCH / BREAKDOWN: You need to list by SOURCE NAME the match-funding source from Federal, State, or Local and the amount from each source. If you have PRIVATE FUNDING SOURCES, you will need to state the amount and what source these private funds came from. YOU MUST COMPLETE ALL SECTION OF THIS REPORT BEFORE YOU SUBMIT TO YOUR ASSET MANAGER.
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