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GRANT APPLICATION Page 6 of 7 <br />,ocal governmental Unit Applying: Indian River CountV Commission <br />town, cavity, or crty <br />.CONTRACTUAL INFORMATION - Complete one for each Delegate Agency <br />General. <br />Name of. Deleaate Aaency: Vero Beech YMCA <br />Address: 3705 16th Street, Vero Beach, Fla. 32960 <br />Contact Person: Terrence D. Marr <br />Telephone: ( )562-903 i or 562-9037 <br />Tar. Exempt Numher: <br />* 59-1321565 = Fed.�� '. 05-00162-00-41 =State # <br />*If none, attach a copy of the certificate of incorporation <br />" w <br />DELEGATE AGENCY BUDGET FOR THIS PROGRAM <br />ADMINISTRATIVE EXPPNSES <br />1. Salaries _ _ 1 Secretary- - - - - - - - - - - - - - $ 600.00 <br />2. RentalSoace --- <br />------------ - - - - -- <br />3. Travel- ----------------------- <br />4. Supplies- -- ------------- <br />5. 0tner (sjecify_��n ^ttachI - - - - - - - - - - - - - — 600.00 <br />6. *TO'? _,T (line s_ 1_throuah-5) _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />PROrRAM EXPFNSFS <br />7. salaries 4_Instructors, 1 Maintenance, 1 Playground- - 3,100.00 <br />8. Vontal-_Space_ __- - - - - ---- <br />------- <br />9. Travel - --------------- <br />- <br />10. Equipment ----------- _ _-_ <br />11. Other ZspecifY-on attachment) - - - - <br />12. TOTAL TiTneS-7 throuah_1Y)- - - - - - - - - - _. - - - <br />- - <br />13. TOTAL EXPF•NSES _(line -6-and-line 12) - - - - - - - - - 4, 195.00 <br />*Mav not exceed 15% of line 13. <br />THE <br />ALL PULES, Ar <br />,PEGULATIONSAANDOVFS THIS CONTRACTSARELATING`,TIJER17TON AND ILL COMPLYpllLl'.S <br />hppnnvFD Fav: Directors YMCA <br />crit le) <br />ATTrc'rrll��: <br />(Title <br />f E B 9 19 77 <br />Sianatur.e) <br />Sicinaturel <br />�?8 437 <br />i <br />