APPENDIX E
The Commonwealth of Massachusetts
Department of Elementary & Secondary Education
75 Pleasant Street, Malden, Massachusetts 02148-4906
PAYMENT NOTIFICATION
1.
RECIPIENT NAME
5.
DATE
6.
APPROVED AMOUNT
$
7. FUNDING SOURCE
CFDA #
2. PROJECT NUMBER
8. PAID TO DATE
A: DISTRIBUTED:
B: PAID DIRECTLY TO MTRS:
3. PROJECT DURATION
9.
AMOUNT OF THIS PAYMENT
$
4. APPROVED BUDGET
ADMINISTRATORS
PROFESSIONAL STAFF
SUPPORT STAFF
MTRS
OTHER FRINGE BENEFITS
CONTRACTUAL SERVICES
SUPPLIES AND MATERIALS
TRAVEL
OTHER COSTS
INDIRECT COSTS
EQUIPMENT
TOTAL APPROVED BUDGET
The identified project has been approved for the amount indicated in item 6 above. A payment in the amount
indicated in item 9 is authorized and will be forwarded by the Treasurer of the Commonwealth.
The project must be administered according to the grant agreement and in compliance with the required and
current Terms and Conditions on file with the Department of Elementary and Secondary Education.
If the payments under the project have not been authorized to the approved amount, please refer to the
instructions on Form RF-1 (Request for Funds) to claim additional funds.
Questions regarding this notice should be referred to the Grants Management staff at (781) 338-6572.
c: Superintendent
Contact Person
Revised 3/2008