Irs 941 Quaterly Report Form by usn17812


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									Council on Domesstic Violence and Sexual Assault
State of Alaska Department of Public Safety
BIP/PBP Quarterly Expenditure/Revenue Report
Program:                                                                          Quarter From:
Grant #:                                                                          Quarter To:

                                                    Original __X__                Revised ______

                                      Annual           First        Second          Third        Fourth               YTD
CDVSA EXPENDITURES                    Budget          Quarter       Quarter        Quarter       Quarter              Total
Personnel Services                                                                                                            0
Travel                                                                                                                        0
Facility                                                                                                                      0
Commodities                                                                                                                   0
Equipment                                                                                                                     0
Contractual                                                                                                                   0
Total CDVSA Expenditure                        0                0             0              0             0                  0

CDVSA                                                                                                                         0
Local Funds                                                                                                                   0
Project Income Cash                                                                                                           0
In-Kind Donation                               0                0             0              0             0                  0
TOTAL REVENUE                                  0                0             0              0             0                  0

Quarterly Tax Filing Dates
IRS Form 941
AK Dept of Labor Form 1004

Briefly discuss spending. Are you on pace to expend the budget by the end of the grant period?
Any unanticipated expenditures during the quarter? Any spending issues to bring to the Council's

I certify that the above information concerning income and expenditures is true and correct, and the expenditures
have been made for the purposes of, and in accordance with, all applicable grant terms and conditions.

Signature of Board President or Treasurer                                                                      Date

Signature of Executive Director or Program Coordinator                                                         Date

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