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Oi~isior, nf Health Services DeveloDr, enba! Disabilities OB <br /> Office, Se~lioq or Branch ' ~ <br /> Effective Date Termination Date ~'5~ ~ r,~%~] <br /> Contractor: Cabarrus Co~ty Health Department Activity: CPipDle~ Chi!~ /<O~9PEDiC <br /> Project Director: William F. Pilkington lo[al Budget: ~,000.00 <br /> Rea] th Director <br /> <br /> [ Salaries. & Fringe Benefit,: ~. ~' <br /> X Purchase o¢ [quipmenZ'.~_" :"- E¥]P 500~ ....... <br /> -~ER' L 6 <br /> General Contracted~'t ~-'C' :~ 2% ' ' A lO0 500 O0 <br /> [ Purchased SeruJde~x~'r.. ~ ~'. ,; <br /> '~ School Health J:, ~'-~cf'~.l[.~"[~ <br /> <br />, D CJinician ~'<'- ~"':' '-'~ CLN 686~ <br /> I Delivery Services : ' ~~~~¢A~3:~.~ ...... ~.~:~ ....... <br /> Laboratory ".' ' " LAB 6862 ... <br /> I Pharmacy Services ....... RX SERV 666P <br /> U Other Professional 01HR PR0 6864 <br /> <br /> R Subtotal 5tBte Expend. $ 2,000.00 <br />" 1 <br /> S LOCAL [XPENDIIURE5: LOCAL EXP 9000 <br /> ]O]~L [XP[ND]]URES - equal to ]oral Receipts $ 2,000.00 <br /> <br />J i OCAL FUNDS: <br /> R j Appropriation APPROP 101 <br /> ' [r, surance Collections I:~SUR COL ]02 <br /> [ Other Receipts OIHR REC <br /> <br />i Subtotal Local Funds $ <br /> E 5IAIE/FEDERAL/SPEC1AL FUNDS: <br />I ! DHS Funds 2,000.00 <br />..¥', <br /> <br /> 5ubtotal State/Federal/SpecJ a~ <br /> -.,~,:~:. ,, $ 2,000.00 <br /> "/-~- .'2' <br /> IOIAL RECEIPI5 -equal to iotal Expe~i~res $ 2,000.00 <br /> <br /> CONTRACIOR SIGNAIURE5 DH5 SIGNATURES <br /> :/~ AUT~iZED~FFICIAL DATE ~,,~- SECTION CHIE~ '-- DAlE <br /> <br /> <br />