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<br />CluMINAl JUSTICE DMSION <br />OmCE OF THE GoVEltNOR <br /> <br />CExrmCAnON To SUI'I'OXT IN-KINo CoNl1U1ltmON OF SWI"LIES <br /> <br />llW""'pap29 oft"" 19$' Pl=.) <br /> <br />VOCA&VAWA <br /> <br />A.. Ust each general category of supplies which is expected to be contributed at full market velue dunng the gram pe.."iod.. <br /> <br />SUlf1v Cat.gors Contributor <br />Norm Office upplies Family Haven <br />Misc. ComDuter SUDDlies Familv Havpn <br />Prin'!-ing ,..,.f M:::+=r;;;1<: ~::'m; ,~, ~;:I\fC\"'l <br />Program Materials Family Haven <br /> <br />TOTAL <br /> <br />Total Value <br />$ 1,500.. 00 <br />S 1 son no <br /> <br />s , . r'lnn nn <br /> <br />S 1. 000.00 <br /> <br />S s onn no <br /> <br />Suppiy Cat.gory <br /> <br />E. Ust eae." gener"; category of supplies which is expected to be purchued at discount du.-;ng the gn..."'lt period.. <br /> <br />S.ll.:;fContributor <br /> <br />Full Muket <br />Volue <br /> <br />s <br />S <br />S <br />S <br /> <br />TOTAL <br /> <br />C. The '= oI the "Total' in A and B. tn.."'lSIer this unO"->1t to line 5, col= 3. page C]D-5. <br />Make su.... that t.lUs total is induded in t.~t of the total in col= 3, Total Supplies and <br />Di.-ect Ope.....t:ing Expenses. CJD-l1. <br /> <br />Disc:ount <br />Given <br /> <br />s <br />s <br />S <br /> <br />S <br />S <br /> <br />S ~ nnn nn <br /> <br />Instruaicr.s: <br /> <br />1. Only ..opplies in "'ew condition may be listed.. <br /> <br />2. Cont:ib1.ltiol'.s fro::! the applicant I !;nIltee are not allowed.. <br />3. Supplies ",ust be r.ceived dur..ng the g:-&."11 period.. <br />4.. Ust or.;y those ite::-.s for which the cor.t:ibutor "'ill sign an affidavit-<>f-won.l, upon delivery. (Not applicable 10 <br />d.isCO~t ?~c:h.ue). <br /> <br />_. Ust only those disco:mts lor which Ll,e cont:ibutor will sign:n affidiVit-<>f:worth Upon delivery And to the effect <br />that Ll,e discount is based enti.-e1y Upon Ll,. nonprofit status of the ..ppli=tl grantee or upOn cha.rit.eble nature of <br />L'>e prog:-=. i.... :lot available to the public at luge. <br /> <br />I <br /> <br />2~ <br /> <br />Fi.n&noaJ O!!ku i.."\ili.a.ls <br /> <br />CJD.ll.2 <br /> <br />.......... <br />