Standard Form 272 7/97 - Federal Cash Transactions Report Form
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1
2OMB APPROVAL NO. 0348-0003
FEDERAL CASH TRANSACTIONS REPORT
1. Federal sponsoring agency and organizational element to which this report
is submitted
(See instructions on the back. If report is for more than one grant or
assistance agreement, attach completed Standard Form 272A.)
4. Federal grant or other identification
5. Recipient’s account number or
2. RECIPIENT ORGANIZATION
number
identifying number
Name:
6. Letter of credit number
7. Last payment voucher number
Number
and Street:
Give total number for this period
City, State
8. Payment Vouchers credited to
9. Treasury checks received (whether
and ZIP Code:
your account
or not deposited)
10.
PERIOD COVERED BY THIS REPORT
3. FEDERAL EMPLOYER
FROM (month, day, year)
TO (month, day, year)
IDENTIFICATION NO.
a. Cash on hand beginning of reporting period
$
b. Letter of credit withdrawls
c. Treasury check payments
11. STATUS OF
0.00
d. Total receipts (Sum of lines b and c)
FEDERAL
0.00
e. Total cash available (Sum of lines a and d)
CASH
f. Gross disbursements
(See specific
g. Federal share of program income
instructions
on the back)
0.00
h. Net disbursements (Line f minus line g)
i. Adjustments of prior periods
j. Cash on hand end of period
$
12.
13.
OTHER INFORMATION
THE
AMOUNT
SHOWN
ON
LINE
11j,
ABOVE,
a. Interest income
$
REPRESENTS CASH RE-
QUIREMENTS FOR THE
ENSUING
b. Advances to subgrantees or subcontractors
$
Days
14. REMARKS (Attach additional sheets of plain paper, if more space is required)
15.
CERIFICATION
SIGNATURE
DATE REPORT SUBMITTED
I certify to the best of my
AUTHORIZED
06/26/2007
knowledge and belief that this
report is true in all respects and
CERTIFYING
TYPED OR PRINTED NAME AND TITLE
TELEPHONE (Area Code,
that all disbursements have
been made for the purpose and
Number, Extension)
conditions
of
the
grant
or
OFFICIAL
agreement.
THIS SPACE FOR AGENCY USE
NSN 7540-01-016-5434
STANDARD FORM 272 (Rev. 7-97)
272-103
Prescribed by OMB Circulars A-102 and A-110
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