+-------------+-------------+---+-----------+-----------+---+-------------+
| **SAMPLE    |             |   |           |           |   |             |
| FORMAT**    |             |   |           |           |   |             |
|             |             |   |           |           |   |             |
| **          |             |   |           |           |   |             |
| SPREADSHEET |             |   |           |           |   |             |
| TO SUPPORT  |             |   |           |           |   |             |
| COSTS       |             |   |           |           |   |             |
| REFLECTED   |             |   |           |           |   |             |
| ON**        |             |   |           |           |   |             |
|             |             |   |           |           |   |             |
| **THE SF    |             |   |           |           |   |             |
| 269         |             |   |           |           |   |             |
| (FINANCIAL  |             |   |           |           |   |             |
| STATUS      |             |   |           |           |   |             |
| REPORT)**   |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| **[Lead     |             |   |           |           |   |             |
| Center      |             |   |           |           |   |             |
| Disbur      |             |   |           |           |   |             |
| sements]{.u |             |   |           |           |   |             |
| nderline}** |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
|             | Ledger Acct | S |           | Cash      |   | In-Kind     |
|             | Numbers\*   | B |           | Match     |   | Match (\$)  |
|             |             | A |           | (\$)      |   |             |
|             |             | F |           |           |   |             |
|             |             | u |           |           |   |             |
|             |             | n |           |           |   |             |
|             |             | d |           |           |   |             |
|             |             | s |           |           |   |             |
|             |             | ( |           |           |   |             |
|             |             | \ |           |           |   |             |
|             |             | $ |           |           |   |             |
|             |             | ) |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
|             | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
|             | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
|             | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| Total Lead  |             | \ |           | \$0.00    |   | \$0.00      |
| Center      |             | $ |           |           |   |             |
| Di          |             | 0 |           |           |   |             |
| sbursements |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| **[Service  |             |   |           |           |   |             |
| Center      |             |   |           |           |   |             |
| Di          |             |   |           |           |   |             |
| sbursements |             |   |           |           |   |             |
| (List by    |             |   |           |           |   |             |
| individual  |             |   |           |           |   |             |
| Service     |             |   |           |           |   |             |
| Center)]{.u |             |   |           |           |   |             |
| nderline}** |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| Service     | Ledger      | S |           | Cash      |   | In-Kind     |
| Center Name | Acct.       | B |           | Match     |   | Match (\$)  |
|             | Numbers     | A |           | (\$)      |   |             |
|             |             | F |           |           |   |             |
|             |             | u |           |           |   |             |
|             |             | n |           |           |   |             |
|             |             | d |           |           |   |             |
|             |             | s |           |           |   |             |
|             |             | ( |           |           |   |             |
|             |             | \ |           |           |   |             |
|             |             | $ |           |           |   |             |
|             |             | ) |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| A           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| B           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| C           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| D           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| E           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| F           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| G           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| H           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| I           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| J           | XXX-XXX     | \ |           | \$0.00    |   | \$0.00      |
|             |             | $ |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | . |           |           |   |             |
|             |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| Total       |             | \ |           | \$0.00    |   | \$0.00      |
| Service     |             | $ |           |           |   |             |
| Center      |             | 0 |           |           |   |             |
| Di          |             | . |           |           |   |             |
| sbursements |             | 0 |           |           |   |             |
|             |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| Total Lead  |             | \ |           | \$0.00    |   | \$0.00      |
| Center and  |             | $ |           |           |   |             |
| Service     |             | 0 |           |           |   |             |
| Center      |             | . |           |           |   |             |
| Di          |             | 0 |           |           |   |             |
| sbursements |             | 0 |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| \* If funds |             |   |           |           |   |             |
| for any of  |             |   |           |           |   |             |
| the above   |             |   |           |           |   |             |
| categories  |             |   |           |           |   |             |
| are housed  |             |   |           |           |   |             |
| in several  |             |   |           |           |   |             |
| accounts,   |             |   |           |           |   |             |
| please      |             |   |           |           |   |             |
| provide all |             |   |           |           |   |             |
| ledger      |             |   |           |           |   |             |
| account     |             |   |           |           |   |             |
| numbers and |             |   |           |           |   |             |
| amounts.    |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| **[         |             |   | **Should  |           |   |             |
| Spreadsheet |             |   | match the |           |   |             |
| C           |             |   | following |           |   |             |
| ategory]{.u |             |   | SF 269    |           |   |             |
| nderline}** |             |   | line      |           |   |             |
|             |             |   | items**   |           |   |             |
| **Total     |             |   |           |           |   |             |
| Lead Center |             |   |           |           |   |             |
| and Service |             |   |           |           |   |             |
| Center      |             |   |           |           |   |             |
| Disbu       |             |   |           |           |   |             |
| rsements:** |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| SBA Funds   |             |   | Item 10j  |           |   |             |
| (\$)        |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| Cash Match  |             |   | Item 10h  |           |   |             |
| (\$)        |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
| In-Kind     |             |   | Item 10e  |           |   |             |
| Match (\$)  |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+
|             |             |   |           |           |   |             |
+-------------+-------------+---+-----------+-----------+---+-------------+