Fillable As560 (Louisiana State University)

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As560 (Louisiana State University)

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Finance and Administration • Office of Accounting Services • Sponsored Program Accounting
240 Thomas Boyd Hall • Baton Rouge, LA 70803 • P 225-578-5337 • F 225-578-7217
REV 8/25/16
CERTIFICATION OF IN-KIND COST SHARING AS560
General Information
Name of In-Kind
Contributor
Award ID
Sponsor
Period Covered
Project Title
Contribution Details
Description
Value of In-Kind Contribution*
Salaries
Fringe Benefits
Equipment
Facility Use
Travel
Operating Service
Materials & Supplies
Other (attach detail)
TOTAL
*Attach supporting documentation detailing contributions.
Certification
I certify that goods or services indicated above were contributed to the referenced project in fulfillment of the committed in-
kind cost sharing contributions. Note: This form should be signed and dated by a certifying official of the contributing
organization who is familiar with the sponsored project and the non-cash contributions made by the applicable organization.
________________________________________________ ____________________________________________
Contributor’s Authorized Representative Print Name
________________________________________________ ____________________________________________
Title Date
Approvals
________________________________________ ____________________________________________ _______________________________________
Principal Investigator Print Name Date
________________________________________ ____________________________________________ _______________________________________
Sponsored Program Accounting Print Name Date
Louisiana State University
Office of Accounting Services
Sponsored Progr
am gam Accountin
240 Thomas Boyd Hall
0.00
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As560 (Louisiana State University)

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Completed 21 July 2020

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