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["The University of the State of New York",null,null,null,null,null,null,null,"REQUEST FOR FUNDS FOR A"]
["THE STATE EDUCATION DEPARTMENT",null,null,null,null,null,null,null,"FEDERAL OR STATE PROJECT"]
["Grants  Finance, Rm. 510W EB",null,null,null,null,null,null,null,"FS-25 (03/17)"]
["Albany, New York 12234"]
[null,null,null,null,null,null,null,null," = Required Field"]
[null,null,"Project #:",null,null,null,null,null,"Contract #:"]
[null,null,null,null,null,null,null,null," "]
[]
[null,null,"Agency Code:"]
[null,null,null,null," "]
["Funding Source:"]
["Agency Name:"]
[]
["Mailing Address:"]
[]
[null,null,null,"Street"]
[]
[]
[null,null,null,"City",null,null,"State",null,null,null,"Zip Code"]
["Contact Person:",null,null,null,null,"Telephone:"]
[]
["E-mail Address:"]
[null,null,null,null,null,null,null,"Report Period:"]
[]
[null,null,null,null,null,null,null,null,null,null,"Month/Year"]
[]
[]
[null,null,null,"CHIEF ADMINISTRATOR'S CERTIFICATION"]
["By signing this report, I certify to the best of my knowledge & belief that the report is true, complete, & accurate, & the expenditures, disbursements,& cash receipts are for the purposes & objectives set forth in the terms & conditions of the Federal (or State) award. I am aware that any false, fictitious,  or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise.  (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)."]
[]
[]
[]
[]
["Date:",null,null,null,"Signature:"]
[]
[]
["1.  Amount of Approved Budget (Include approved amendments)",null,null,null,null,null,null,null,null,"$"]
[]
["2.  Project Payments Received to Date",null,null,null,null,null,null,null,null,"$"]
[]
["3.  Project Cash Expenditures to Date",null,null,null,null,null,null,null,null,"$"]
[]
["4.  Cash Expenditures Anticipated During Next Month:",null,null,null,null,null,null,null,null,"$"]
[]
["5.  Additional Funds Requested (Entries 3 plus 4 minus 2)",null,null,null,null,null,null,null,null,"$",{"$f":"K43+K41-K39","v":0}]
[]
[null,null,"FOR DEPARTMENT USE ONLY"]
[]
[null,null,null,null,null,null,"Fiscal Year",null,"Payment Split",null,null,"Line #"]
["Voucher #:",null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,null,"$"]
["Finance:",null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,null,"$"]
[null,"LOG",null,"MIR",null,null,null,"$"]