Common use of Reporting Form Clause in Contracts

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx, OR 97906 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 126.37 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3304001 Dufur SD 66 29 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 XX 0xx Xxxxxx Xxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 510.85 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1503002 Jackson County SD 66 #6 ‐ Central Point Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxxxxxx Xxxxxx Xxxxxxx Xxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,099.38 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 1603003 Xxxxxx SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP. O. Box 259 Culver, OR 97906 97734 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,612.74 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3402001 Banks SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx00000 XX Xxxx Xxxxxx Xxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 993.09 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0613002 Myrtle Point SD 66 41 Business Manager 0000 Xxxxxx/Xxxxxxxx 000 X Xx XxxxxxMyrtle Point, OR 97906 97458 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,097.60 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx SD 66 1805001 Eagle Ridge High Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxxx 0xx Xxxxxx Klamath Falls, OR 97906 97601 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 21,940.89 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2002003 Blachly SD 66 90 Business Manager 0000 Xxxxxx/Xxxxxxxx 00000 Xxxxxxx Xxxxxx Xx XxxxxxXxxxxxx, OR 97906 97412 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 324.31 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3005001 Echo SD 66 5 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxxxx Xxxxxx ECHO, OR 97906 97826 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,737.19 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3008005 Hermiston SD 66 8 Business Manager 0000 Xxxxxx/Xxxxxxxx 000 XX 00xx Xx XxxxxxHermiston, OR 97906 97838 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 5,425.89 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0102002 Burnt River SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 9 Unity, OR 97906 97884 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 4,787.58 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0307001 Gladstone SD 66 115 Business Manager 0000 Xxxxxx/Xxxxxxxx 17789 Xxxxxxx Xx XxxxxxGladstone, OR 97906 97027 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 45,497.19 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1004001 Days Creek SD 66 15 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 10 Days Creek, OR 97906 97429 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 12,776.94 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2003009 Crow‐Applegate‐Xxxxxx SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx00000 Xxxxxxxxxxx Xxxx Eugene, OR 97906 97402 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 80,671.46 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1408001 Hood River SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxxx Xxxxxx Hood River, OR 97906 97031 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 13,453.66 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2419011 St. Xxxx SD 66 45 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx00000 Xxxx Xx. XX Xx. Xxxx, OR 97906 97137 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,260.08 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2509001 Xxxx SD 66 R2 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP.O. Box 167 Ione, OR 97906 97843 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,495.55 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2407001 Xxxxxxx SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 100 Gervais, OR 97906 97026 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 56,932.56 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2706001 Falls City SD 66 57 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 X Xxxx Xxxxxx Xxxxx Xxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,341.66 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx SD 66 1303002 Crane Union High School Business Manager 0000 Xxxxxx/Xxxxxxxx 43277 Crane‐Venator Xx XxxxxxXxxxx, OR 97906 97732 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 6,392.64 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0401002 Astoria SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxxxxx Xxxxxx Astoria, OR 97906 97103 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 405.39 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3109001 Imbler SD 66 11 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 164 Imbler, OR 97906 97841 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 11,204.93 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0603005 Coquille SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 X Xxxxxxx Xxxx Xxxxxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 7,993.54 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0314001 North Clackamas SD 66 12 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx00000 XX Xxxxxxx Way Milwaukie, OR 97906 97222‐4799 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,914.75 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0203003 Corvallis SD 66 509J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXX 00xx Xx. Corvallis, OR 97906 97333 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,150.48 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2010001 Junction City SD 66 69 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxxx Xxxxxx Junction City, OR 97906 97448 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 468.18 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2003008 Xxxxxxxx SD 66 40 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 X Xxxxxx Creswell, OR 97906 97426 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,141.70 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0303003 Canby SD 66 86 Business Manager 0000 Xxxxxx/Xxxxxxxx X Xxx Xx XxxxxxXxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 38,169.47 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2607003 Xxxxxxx‐Xxxxxx SD 66 10J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXX Xxxxxxx Parkway Gresham, OR 97906 97030 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 22,076.14 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3103003 Cove SD 66 15 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 68 Cove, OR 97906 97824 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 5,386.82 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0602001 Bandon SD 66 54 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx 000 0xx Xxxxxx XX Xxxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,307.78 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1007002 Glide SD 66 12 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx00000 X Xxxxxx Xxx Xxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,423.19 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3614001 Xxxxxxx SD 66 29J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 X Xxxxx Xxxxxx Newberg, OR 97906 97132‐3406 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 155,565.69 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0902001 Bend/XxXxxx SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 XX Xxxx Xxxxxx Xxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,127.05 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3019001 Xxxxxxxxx SD 66 61 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxx Xxxx Stanfield, OR 97906 97875 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 14,516.59 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2410001 Xxxxxxxxx SD 66 14J Business Manager 0000 Xxxxxx/Xxxxxxxx X 0xx Xx XxxxxxXxxxxxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 5,174.43 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0703001 Xxxxx Co SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 XX Xxxxxx Xxxxx Xx. Xxxxxxxxxx, OR 97906 XX 00000‐8467 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 11,280.79 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0503001 Clatskanie SD 66 6J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 678 Clatskanie, OR 97906 97016 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,086.80 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 1103001 Xxxxxx SD 66 25J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 X.Xxxxxx Condon, OR 97906 97823 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 12,079.20 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1019001 South Umpqua SD 66 19 Business Manager 0000 Xxxxxx/000 XX Xxxxxxxx Xx XxxxxxXxxx Xxxxxx Creek, OR 97906 97457 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 727.63 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2208001 Harrisburg SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 208 Harrisburg, OR 97906 97446 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,501.03 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0305002 Estacada SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 XX 0xx Xxxxxx Xxxxxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,349.60 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1019003 Sutherlin SD 66 130 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx531 E Central Sutherlin, OR 97906 97479 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,126.07 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3601002 Amity SD 66 4J Business Manager 0000 Xxxxxx/Xxxxxxxx 000 X Xxxxx Xx XxxxxxXxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 47.15 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1502001 Butte Falls SD 66 91 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP.O. Box 228 Butte Falls, OR 97906 97522 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 562.79 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0603004 Coos Bay SD 66 009 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxxxx Xxx. Coos Bay, OR 97906 97420 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,799.14 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1707001 Grants Pass SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxx Xxxxxx Grants Pass, OR 97906 97526 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 409.04 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2019007 Springfield SD 66 19 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 X Xxxxxx Springfield, OR 97906 97477 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 67,234.91 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1014001 North Xxxxxxx SD 66 22 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 338 Drain, OR 97906 97435 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 19,372.44 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0614001 North Bend SD 66 13 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxx Xxxxxx North Bend, OR 97906 97459 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 69,881.29 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2002002 Bethel SD 66 52 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxxx Xxxxx Eugene, OR 97906 97402 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,747.89 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2703001 Central SD 66 13J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 X Xxxxx Xx. Independence, OR 97906 97351 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 880.33 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3205001 Enterprise SD 66 21 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx201 S.E. 4th Enterprise, OR 97906 97828 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 372.54 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 3407001 Xxxxxx SD 66 511J Business Manager 0000 Xxxxxx/Xxxxxxxx 000 Xxxx Xx Xxxxxx, OR 97906 97119 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 18,741.59 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1610001 Jefferson Co SD 66 509 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx 000 XX Xxxx Xxxxxx Xxxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,916.28 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 0303007 Xxxxxx SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx 00000 X. Xxxxx Xxxx Road Xxxxxx, OR 97906 97017 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,078.42 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3604001 Dayton SD 66 008 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP.O. Box 219 Dayton, OR 97906 97114‐0219 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 322.48 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx SD 66 1704002 Dome School Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxxxx Xxxx. Cave Junction, OR 97906 97523 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 6,092.75 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1811002 Klamath Co SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxXxxxxxxxxxxx XX Klamath Falls, OR 97906 97601 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,438.14 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3105002 Elgin SD 66 23 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 68 Elgin, OR 97906 97827 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,398.19 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2019006 South Lane SD 66 45J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP.O. Box 218 Cottage Grove, OR 97906 97424 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 11,058.14 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2413003 Mt. Angel SD 66 91 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 1129 Mount Angel, OR 97906 97362 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 4,804.50 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2603013 Xxxxxxx SD 66 39 Business Manager 0000 Xxxxxx/00000 X Xxxxxxxx Xx XxxxxxXxxxxxxx Xxxxx Xxxxxxx Xxxxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,778.17 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0102001 Xxxxx SD 66 5J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx0xx Xx. Baker City, OR 97906 97814 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 18,562.44 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0108001 Xxxxxxxxxx SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxxx Xxxxxx X Xxxxxxxxxx, OR 97906 XX 00000 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 912.69 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0802001 Brookings‐Harbor SD 66 17 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxx Xx. Brookings, OR 97906 97415 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 2,245.62 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2203003 Central Linn SD 66 552 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 200 Halsey, OR 97906 97348 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 15,293.54 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2403005 Cascade SD 66 005 Business Manager 0000 Xxxxxx/Xxxxxxxx 00000 Xxxxxx Xx XX Xxxxxx, OR 97906 97392 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 36,451.96 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 1308001 Xxxxxx Co SD 66 3 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx000 Xxxxx Xxxx Burns, OR 97906 97720 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 675.29 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 2006003 Xxxx Xxxxx SD 66 28J Business Manager 0000 Xxxxxx/Xxxxxxxx 00000 Xxxxxxxxxxx Xx XxxxxxElmira, OR 97906 97437 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 5,754.43 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1007001 Glendale SD 66 77 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box E Glendale, OR 97906 97442 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 21,434.18 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3506001 Fossil SD 66 21J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 287 Fossil, OR 97906 97830‐0287 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 8,325.40 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 2005005 Xxxxxx SD 66 4J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx200 N MONROE EUGENE, OR 97906 97402 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 825.54 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1003001 Camas Valley SD 66 21J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 57 Camas Valley, OR 97906 97416 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 7,105.47 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1213001 Monument SD 66 8 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP.O. Box 127 Monument, OR 97906 97864 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 453.34 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1101001 Arlington SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP.O. Box 10 Arlington, OR 97906 97812 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 733.60 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 1501002 Ashland SD 66 5 Business Manager 0000 Xxxxxx/000 Xxxxxxxx Xx XxxxxxXxxx. Ashland, OR 97906 97520 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,574.96 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0201001 Alsea SD 66 7J Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box B Alsea, OR 97906 97324 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 6,927.85 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3319001 South Wasco Co SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxP.O. Box 346 Maupin, OR 97906 97037 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 $ 257.77 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 2513001 Xxxxxx Co SD 66 Business Manager 0000 Xxxxxx/000 Xxxxxxxx Xx XxxxxxXxxx Irrigon, OR 97906 97844 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,025.30 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 3519001 Spray SD 66 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 230 Spray, OR 97906 97874 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 22,798.78 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 Xxxxxx 0803001 Central Xxxxx SD 66 1 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx Xxxxxx00000 Xxxxxxxxxx Xxx. Gold Beach,, OR 97906 97444 National School Lunch Program State Revenue Matching

Reporting Form. Instructions: • Complete the information requested for the state match transfer • Sign and date this form • Provide documentation of the transfer of funds from General Fund to the Non‐Profit School Food Service account. Documentation needs to show exact amount of required State Match. This may require a journal entry marked “State Match Requirement” • Return to: xxx.xxxxxxxxxxxxxxx@xxx.xxxxxx.xxx Subject: State Match • Retain a copy of this form and the supporting documentation for record keeping purposes The amount of state appropriated general purpose or undesignated revenues that must be transferred to the Non‐Profit School Food Service account in order to meet the general cash assistance match for SY 2022‐23 is: $2,162.76 1,455.99 The required match was made by: Fund Transfer from General Fund to the Non Profit Food Services Account: Date Amount Agreement: 2308001 1005001 Xxxxxx SD 66 34 Business Manager 0000 Xxxxxx/Xxxxxxxx Xx XxxxxxPO Box 390 Elkton, OR 97906 97436 National School Lunch Program State Revenue Matching