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[]
[null,"Program Name","Contract Ref. Number:"]
[]
[]
[null,"Contractor Name","FIN/SSN (no dashes)","Contract Start Date","Contract End Date"]
[]
[]
[null,"Street Address","City","State (2 Letter Abbr)","Zip Code (5 digit)"]
[]
[]
[null,"Total Contract Amount","Amount Received To Date","Total Reimbursement Req","Is this the Final Invoice?"]
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[]
[null,"Indirect Rate"]
[]
[null,"Summary Data:"]
[null,"Account","Reimbursement Amount"]
[null,"Salary",0]
[null,"Overtime",0]
[null,"Fringe",0]
[null,"Contract",0]
[null,"Consultant",0]
[null,"Equipment",0]
[null,"Supplies",0]
[null,"Travel",0]
[null,"Other/Misc",0]
[null,"Indirect",0]
[null,"Total ",0]
[]
[]
[null,"Original Receipt and Invoice Certification"]
[]
[null,"I certify that original receipts and invoices are maintained on file at the office of the Organization "]
[null,"list below, located at the address listed below, and will remain available there for a minimum "]
[null,"of seven (7) years for audit purposes."]
[]
[null,"Contact Name:"]
[null,"Organization Name:"]
[null,"Organization Address:"]
[]
[null,"Authorized Signature:",null,"Date:"]
[]
[]
[null,"Signature/Certification"]
[]
[null,"I certify that to the best of my knowledge and belief, the data reported above is correct, and all"]
[null,"outlays were made in accordance with the contract conditions, and that payment is due and has"]
[null,"not been previously requested."]
[]
[null,"Preparer's Name"]
[null,"Preparer's Phone"]
[null,"Preparer's Email"]
[null,"Preparer's Signature:",null,"Date:"]
[]
[null,"Authorizer's Name"]
[null,"Authorizer's Phone"]
[null,"Authorizer's Email"]
[null,"Authorizer's Signature:",null,"Date:"]

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["Category","Item/Description","Vendor Name","Vendor ID","Contract Period Start Date","Contract Period End Date","Unit of Measure","Hrs/Qty","Rate/Unit Cost","Extended Cost","Remarks","Receipt #"]