Form YG6601 "Gas Tax Fund Progress Claim Form / Cash Flow" - Yukon, Canada

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Download Form YG6601 "Gas Tax Fund Progress Claim Form / Cash Flow" - Yukon, Canada

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GAS TAX FUNDING
PROGRESS CLAIM FORM / CASH FLOW
ADVANCED BASED PAYMENT FUNDING
Recipients receiving Gas Tax funding are required to use only this form for progress claims. Be sure to include (and attach) all supporting documentation, receipts and photos.
TRANSFER PAYMENT AGREEMENT DETAILS
Recipient
Funding amount/project amount approved
Project title
Project number
TPA number: T000
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Project start date
Project completion date
CASH FLOW PROJECTIONS / FINANCIAL REPORTING
Reporting period
Reporting period
Reporting period
Reporting period
Reporting period
Cash flow projections are required to project
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
first and interim payments. Financial reporting is
From:
From:
From:
From:
From:
required to show advance payments (progress
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
to:
to:
to:
to:
to:
claims) were fully expended.
 Projected
 Actual
 Projected
 Actual
 Projected
 Actual
 Projected
 Actual
 Projected
 Actual
Revenue
(funding sources)
YG Gas tax funding
YG other:
Other:
TOTAL REVENUE $
$
$
$
$
0.00
0.00
0.00
0.00
0.00
Expenditures
(list expenditures / identify project phase)
TOTAL EXPENDITURES $
$
$
$
$
0.00
0.00
0.00
0.00
0.00
Note: If your list of expenditures is greater than the space provided OR you
Attached separately?
Percentage of the project that is complete:
%
have more reporting periods, attach separately with the spreadsheet provided.
Yes
No
Have there been any changes to the scope or the timing of the project?
Yes
No
Additional information attached?
Yes
No
RECIPIENT CERTIFY / AUTHORIZED SIGNATURES
All Claims – I certify that costs stated above have been incurred and paid and are attributable to this project, are eligible and net of tax and any other rebates/grants and are in accordance with the provisions of the
Canada/Yukon Gas Tax Administrative Agreement. I acknowledge that all claims made under this program are subject to all audit and records are being maintained as defined in Section 10 Schedule A of the funding
Agreement. The information contained on this form is collected under Section 161 of the Keeping Canada’s Economy and Jobs Growing Act, S.C. 2011, C.24 and the Canada-Yukon Gas Tax Administration Agreement
and will be used for the purpose of administering the Gas Tax Fund. For further information, contact the Gas Tax Fund Administrator at (867) 336-0469, toll free within Yukon 1-800-661-0408, ext.5111.
Name and position:
Signature:
Date
Y Y Y Y
/
M M
/
D D
YG(6601EQ)F1 10/2018
Print
Clear
GAS TAX FUNDING
PROGRESS CLAIM FORM / CASH FLOW
ADVANCED BASED PAYMENT FUNDING
Recipients receiving Gas Tax funding are required to use only this form for progress claims. Be sure to include (and attach) all supporting documentation, receipts and photos.
TRANSFER PAYMENT AGREEMENT DETAILS
Recipient
Funding amount/project amount approved
Project title
Project number
TPA number: T000
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Project start date
Project completion date
CASH FLOW PROJECTIONS / FINANCIAL REPORTING
Reporting period
Reporting period
Reporting period
Reporting period
Reporting period
Cash flow projections are required to project
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
first and interim payments. Financial reporting is
From:
From:
From:
From:
From:
required to show advance payments (progress
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
Y Y Y Y
/
M M
/
D D
to:
to:
to:
to:
to:
claims) were fully expended.
 Projected
 Actual
 Projected
 Actual
 Projected
 Actual
 Projected
 Actual
 Projected
 Actual
Revenue
(funding sources)
YG Gas tax funding
YG other:
Other:
TOTAL REVENUE $
$
$
$
$
0.00
0.00
0.00
0.00
0.00
Expenditures
(list expenditures / identify project phase)
TOTAL EXPENDITURES $
$
$
$
$
0.00
0.00
0.00
0.00
0.00
Note: If your list of expenditures is greater than the space provided OR you
Attached separately?
Percentage of the project that is complete:
%
have more reporting periods, attach separately with the spreadsheet provided.
Yes
No
Have there been any changes to the scope or the timing of the project?
Yes
No
Additional information attached?
Yes
No
RECIPIENT CERTIFY / AUTHORIZED SIGNATURES
All Claims – I certify that costs stated above have been incurred and paid and are attributable to this project, are eligible and net of tax and any other rebates/grants and are in accordance with the provisions of the
Canada/Yukon Gas Tax Administrative Agreement. I acknowledge that all claims made under this program are subject to all audit and records are being maintained as defined in Section 10 Schedule A of the funding
Agreement. The information contained on this form is collected under Section 161 of the Keeping Canada’s Economy and Jobs Growing Act, S.C. 2011, C.24 and the Canada-Yukon Gas Tax Administration Agreement
and will be used for the purpose of administering the Gas Tax Fund. For further information, contact the Gas Tax Fund Administrator at (867) 336-0469, toll free within Yukon 1-800-661-0408, ext.5111.
Name and position:
Signature:
Date
Y Y Y Y
/
M M
/
D D
YG(6601EQ)F1 10/2018
Print
Clear