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State of New Jersey
Department of Children and Families
Annex B-3 Budget/Expenditure Report
Provider Name:
Program Name: Budget Expense
Contract/Program Period: To Mod Final
Contract #:
General & Administrative
Totals $ -
Cost Shared/Revenue $ -
DCF Costs $ -
Special Remarks/Conditions:
I certify that the cost data dused to prepare the budget and the expenditures reported herein are current, accurate,
and in accordance with the contract terms and governing principles for determining costs.
Authorized Signature: Date:
Type of Report:
(circle one)
Budget Category/
Items:
Budgeted
Cost