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" P # P $  $  %   & ` '      (  ) * a8 +  1" 1 & &    # 1  #    "   a        `  ` 1  #@  1"@  @ 1   1"@  "``     /  " "f`  "``             a   a  !@  ! ! !  &  &  " "` "  "  "@  #@   @ @  "ff   @   `        ` &@@ &@ &P @ &@ &P  @  P #@  @  P  !@@  "P @   @ P  "P @/ P 1  @ 1 P 1 @ 1 P   @@   @  P  @@  P @  &P   P  e@ !P   P !  #  @ 1#P # 1"@ "@ "P @ #@  `a    a   `   `  `  P   "Q@ @ 1!  0    " @       @ @ # " "@ " " "V  "@ !  1!P   1"@ @ & "@ @ "@ @ "@@ " @ 1"`   ,   ,@   ,@ @ "@@  4 @  "@@  "@  "P @ 1"@ 1"`@ 1! 1!P 1!  #  #P  1"@   8P @ 1!@ 1! 1!P  "`  "`  "``  "@@   "@   " @   ""@@   ""@   "" @  1 A 1P A !@ !8 "@ "8 "` "` "`` 1!@ 1! 1!P 1!@ !@ ! !P  1"  1"5MEAMOUNTFederalTOTALSAmount Budgeted:Amount Previously Obligated:Balance:Date: (Start Date) (End Date)State General FundInteragency TransfersFees and Self Gen.Statutory DedicationFiscal Year for this BA-22: (yyyy-yy)Amendment Start/End Dates:,(Provide a statement of "Services Provided")BA-22 Start/End Dates:Name: Title: Phone: Reviewed/Approved By: Date of Cancellation:1(Provide rationale for amendment or cancellation)(Contractor/Vendor No.)(Contractor/Vendor Name)MEANS OF FINANCING Current YearTotal Contract%If not, explain.FOR AGENCY USE ONLYZ(Start Date) (End Date)!If "Yes", provide contract dates:o*Specify Source (i.e., grant name, fund name, IAT sending agency and revenue source, fee type and source, etc.)Amount this BA-22:Agy/Prg Contact: Board of RegentsDept/Agency/Program Name:Agency/Program BA-22 # :Dept/Budget Unit/Program #:Agency/Program Contract #:>This information is to be provided at the Agency/Program LevelzThe approval of the aforementioned contract will not cause this agency/program to be placed in an Object Category deficit.(225) 342-4253671Contract Amendment (Yes/No):Contract Cancellation (Yes/No):YesXAre revenue collections for funds utilized above in line with budgeted amounts? 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