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<br /><-, <br />.. <br /> <br />CIuMlNAL JtlSTICE DMSION <br />OFFICE OF 1HE GOVERNOR <br /> <br />(!W... to pap 29 01 tho alii PlaA.) <br /> <br />CElamCAnON To SUI'I'ORT IN-KrNo CoN'IlUBvnON OF Si:JPnlES <br /> <br />VOCA&VAWA <br /> <br />A. List elch general category of supplies which is expected to be contributed It full market value dUIing the grant period. <br /> <br />SUIto Catego'$ Contributor <br />Norm ffiee upplies Family Haven <br />Mise. CDmDut~r SUDDlies Familv Hav~n <br />P,..;nt;n~ ,.,of M='!-~,..;=1f: ~::lm;'J' ~=\I0" <br />Program Materials Fami ly Haven <br /> <br />ToQ! Value <br />S 1,500.00 <br /> <br />s' "inn nn <br /> <br />S, nnf) nn <br />. <br /> <br />S 1. 000.00 <br /> <br />TOTAl <br /> <br />S "i nnn nn <br /> <br />3, Ust each gene.--.l cat.egory of supplies which is expected to be p1.L."'C..""-sed at discount dur'~"1g to....e gnnt period. <br /> <br />Supply Category <br /> <br />SeUe:fContributor Full Maricet Disc:ouut <br />Value Given <br />S S <br />S S <br />S S <br />S S <br />TOTAL S <br /> <br />C. The -= of the '"joW'ln A and E, !::'ulsfer this =o=t to line 5, col=.n 3, page C]D-S. <br />Make su.... that t..'Us toW is lncluded In t........t of the total In cohm~ 3, ToW Supplies and <br />!)i..rect Ope....ti."1gExpemes, C]D-11. <br /> <br />S <; 000 on <br /> <br />InstTuaions: <br /> <br />1. Only "'pplies in new condition m.y be listed. <br /> <br />2. Contrib",C:or.s fro=. the ..ppli=t/ grantee ..... not allowed. <br /> <br />3_ Supplies must be received dur..:>g the g:or.t period. <br /> <br />4. list Ol"Jy those it."... for which the contn.outor will sign an affid..vit.:of-wort.~ upon delive::'. (Not .pplicable to <br />discount pu:c:.~e). <br /> <br />5. list oniy those discounts for whic.~ the cont:rib1:to.. will sign an affid."it-of-worth Upon delivery :.nd to the eHect <br />t.......t l..~e discou."1t is b~ed entirely upon the nonprofit status of the .ppli=t/ gnntee or "'pon charitable nature of <br />l..>'e prognm. i.e.. ;lot available to the p",blic at luge. <br /> <br />2~ <br /> <br />Fi,"\a"l\a.J01!iceri.....:li.als <br /> <br />CJD-l1.2 <br /> <br />........... <br /> <br />II <br />