sample-claim-excel-01-28-13

Page 1

Louisiana Department of Education Request for Funds-Continuation Sheet Name of Eligible Recipient: Orleans Parish School Board Project No.: 28-13-T1-36 Amount Approved: $26,141,152.00 Type of Funding: Federal __X__ State _____

Request No.: Sheet 2 of 3 Sheets

0

Program: TITLE 1 Date Approved _09/28/12__Program Fiscal Year: 2012-2013

AMOUNT REQUESTED Check #

FOR THE SALARIES - GIVE THE PERIOD COVERED Check Date Name of Vendor

Use of Funds Object Code

Amount

payroll payroll payroll payroll payroll payroll payroll payroll payroll payroll

04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12

Jane Doe 112 Jane Doe 112 Sue Edwards 112 Sue Edwards 112 Jennifer Jones 112 Jennifer Jones 112 Jonathan Murphy 112 Jonathan Murphy 112 Rachel Smith 112 Rachel Smith 112 TOTAL FOR OBJECT CODE 100:

$920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $9,200.00

payroll payroll payroll payroll payroll

04/30/12 04/30/12 04/30/12 04/30/12 04/30/12

payroll payroll payroll payroll payroll payroll payroll payroll payroll payroll

04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12

payroll payroll payroll payroll payroll payroll payroll payroll

04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12 04/15/12 04/30/12

Jane Doe 210 Sue Edwards 210 Jennifer Jones 210 Jonathan Murphy 210 Rachel Smith 210 total for object code 210: Jane Doe 225 Jane Doe 225 Sue Edwards 225 Sue Edwards 225 Jennifer Jones 225 Jennifer Jones 225 Jonathan Murphy 225 Jonathan Murphy 225 Rachel Smith 225 Rachel Smith 225 total for object code 225: Jane Doe 231 Jane Doe 231 Sue Edwards 231 Sue Edwards 231 Jennifer Jones 231 Jennifer Jones 231 Jonathan Murphy 231 Jonathan Murphy 231 total for object code 231, page 2:

$339.91 $18.51 $38.15 $339.21 $340.17 $1,075.95 $13.12 $13.12 $13.12 $13.12 $12.19 $12.19 $12.19 $12.19 $13.45 $13.45 $128.14 $214.38 $214.38 $214.38 $214.38 $199.30 $199.30 $199.30 $199.30 $1,654.72

(If Applicable) 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S 6A1510XX 511200 13T1S

6A1510XX 521000 13T1S 6A1510XX 521000 13T1S 6A1510XX 521000 13T1S 6A1510XX 521000 13T1S 6A1510XX 521000 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 522500 13T1S 6A1510XX 523100 13T1S 6A1510XX 523100 13T1S 6A1510XX 523100 13T1S 6A1510XX 523100 13T1S 6A1510XX 523100 13T1S 6A1510XX 523100 13T1S 6A1510XX 523100 13T1S 6A1510XX 523100 13T1S


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