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<br />-n E.T A I L S 0 FAT T A C H MEN T S <br /> <br />Attl DSHS Program 101 Term Financial Assistance Direct Total Amount <br />Amd DSHS Purchase Assistance (DSHS Share) <br />No. Order Number Begin End Source of Amount <br /> Funds* <br />01A IMM/LOCALS 01/01/04 12/31/04 State 93.268 33,389.00 0.00 33,389.00 <br />o00ooo1782 <br />02 ACFHIPHC 09/01/04 08/31/05 151,558.00 0.00 151,558.00 <br />C038917000 <br />03 OPHP/LPHS 09/01/04 08/31/05 120,519.00 0.00 120,519.00 <br />C039254000 <br />DSHS Document No.7560022067 2005 Totals $305,466.00 $ 0.00 $305,466.00 <br />Chan5e No. 03 . <br /> <br />*Federal funds are indicated by a number from the (;:atalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO <br />BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS. <br /> <br />J. <br /> <br />Cover Page 2 <br />