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FINANCIAL STATUS REPORT <br /> (Short Form) <br /> (Follow instructions on the back) <br /> 1. Federal Agency arts Organ¢a8onal Element 2. Federel Grantor Other Idenfitying Number Assigned OMB Approval Page of <br /> to which Report is Submitted By Fede21 Agency No. <br /> USDA Rural Development Community Facilities Grant - Pahala a3ae-0o3s 1 1 <br /> pages <br /> 3. Redpient Organization (Name and complete address, including ZIP code) <br /> County of Hawaii Fire Department, 25 Aupuni Street, Room 102, Hilo, Hawaii 96720 <br /> <br /> 4. Employer Idenfification Number 5. Redpient Account Number or Identifying Number 6. Final Report 7. Basis <br /> 99-6000567 610010996000567 Yes ? No? Cash ? Accrual <br /> 8. FundinglGrent Period (See inshuc6ons) 9. Pedod Covered by this Report <br /> From: (Monts, Day, Year) To: (Month, Day, Year) From: (Month, Day, Year) To: (Month, Day, Year) <br /> 5/20/2005 5/20/2010 5/2012005 9!30/2007 <br /> 10. Transactions: I II III <br /> F'reviousty This Cumulative <br /> Reported Period <br /> a. Total outlays 0.00 24,995.36 24,995.36 <br /> b. Redpiern share otoutlays 0.00 6,248.84 6,248.84 <br /> c. Federal share of outlays 0.00 18,746.52 18,746.52 <br /> s, <br /> E• <br /> d. Total unl'puidated obrga8ons ~ t t _ _~I~,"v ~ ~ 0.00 <br /> e <br /> e. Redpient share of unliquMated obligations - ~r~^".,~ r .4~~ Ott 0.00 <br /> ~x <br /> L Federal share of udiquidate0 obligafions S,7 ~_g+~, ~ ' 0.00 <br /> _ w ~ r gr ,t T ry <br /> g. Tofai Federal share(Sum ollines c and 0 ~ ~'P,cp ~ ~ ~ 18,746.52 <br /> x~'~dr <br /> ~ € xi ~ ,firs ~~rr d~ - <br /> h. Total Federal funds author'¢sd for this funding period - n ~ - ~ 18,746.52 <br /> L Unobligated balance of Federal fund~Lfne h minus line g) ~ ~ ~,..N a ~ 0.00 <br /> a. Type d Rate(Place X' in appropriate box) <br /> 11. Indirect ? Provisional ? Predetermined ? Finai ? Fixed <br /> Expense b. Rate c. Base d. Total Amount e. Federal Share <br /> 12. Remarks: Attach any exylanations deemed necessary or information required try Federal sponsoring agency in compliance with governing <br /> legislation. <br /> See attachment. <br /> 13. CerBfirafion: I eeRity to the best of my knowledge and belie(thaf this report is correct and eanplete and that all outlays and <br /> unliquidated obli ations are for the purposes set forth in the award documents. <br /> Typed or Printed Name and Title Telephone (Area code, number and extension) <br /> Darryl J. Oliveira, Fire Chiet (808)981-8394 <br /> Signature o uthodzed Cedifying Offidal Date Repod Submitted <br /> August 8, 2007 <br /> NSN 40-01-2 387 269-202 Standard Forn 269A (Rev. 7.97) <br /> Prescribed by OMB C'ucuWrs A-102 and A-11( <br /> <br />