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n <br />a <br />a <br />GRANT APPLICATION Paqc 4. of 7 <br />Namn of. Applicant: Indian River County Commission <br />Fiscal Officer Responsible for Grant: <br />Name: Mr. William Jackson <br />Address: • ox , ero each, <br />Fl. 32966 -- <br />Telephone - - <br />11. TOTAL RUMET <br />(Include figures from all programs operated) <br />. 1 � <br />1. REVENUE <br />1. state Grant_ ____ ______________ 5,265.00 <br />2. Cash r4atch (no federal funds, exceptscyenue_sha�ng, a.1IDwgd)_. 9,775.00 <br />3. In=Kind Match _ __-____ 5,768.00 <br />4. TOT)d uFVrinF------------------ 20,808.00 <br />r,RANTEF AD114TNISTPA:I'TVF EXPENSF <br />5. Sal.ar.ies-------------------- <br />6. cental_Space--------------- - - - - -- <br />7. Travel --------- - - - - - - -- ----- <br />8. Supplies ________'___- <br />9. Other (srecifv on attachment) - _ _ _ - _ _ _ _ _ _ _ <br />10. Total (15.nec_S_throuah_9) _ - _ _ _ , _ _ _ _ _ _ _ _ <br />DELEGATE ADMTNISTRATTVr, EXPENSE. <br />11. salaries_____________________ 792.00 in kin <br />12. Rental Space_____________________ <br />13. Travel --------- - - - - -- -- - -- <br />14. Supplies <br />15. Qthpr (specify -on <br />16. Total (lines 11 through 16) - _ _ _ _ _ __ _ _ <br />17. T7AL TAnI%�IyI_TP.ATIVF-CASTS* (Line 10 -and -Line 16) _ 792.00 in kir._ <br />GItANTi:F PR:)C PAM F.XPF.NSE <br />18. <br />salaries- - - - -- - - - - - - - -- - - - - - <br />19. <br />Rental -------------- - - - - -- <br />520.00 <br />' <br />20. <br />-Space <br />Travel ---------------------- <br />21. <br />Fcruirment ------------ <br />22., <br />--_ -- <br />Cther. (srecif�y on attachment_ _ _ _ _ _ _ _ _ _ _ _ <br />23. <br />_ <br />Total Tlines_18 through 22) _ _ _ _ _ _ _ _ _ _ _ <br />bmr:nATi' PP0f:'2AM EXPENSE <br />3,456.00 in kin: <br />24. <br />Salaries_______________ <br />4,320.00 <br />-Tin <br />•25. <br />?ental Space_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />t n _ <br />26. <br />Travnl <br />000.00 <br />' <br />27. <br />---------------------- <br />Fn1i`ment = -- ---- --- <br />2g, <br />--- <br />nt►=er. (sLc'ci fv_on attachment) - f-orjeat_ - - - - _ _ <br />29. <br />Total (lines_ ?.4 through fST _ _ _ _ _ _ _ _ _ _ _ _ _ <br />1,496'On <br />30. <br />Tn^A>; Prnrimm r:jPr`ISt'S (Line -23 and line_29)_ _ _ _ _ <br />20.016.00 <br />31. <br />TOTAL F.XPr.`JnIT11PrS (Line_17 and line -30)_ _ _ _ _ _ _ <br />20.808.On <br />JnTJ.: TOTAL Prvr*gvF. MUST EOUAL TOTAL EXPE-NDITURES <br />-*!Inv not excoeri 154. of 2 times the state grant <br />• <br />EXAMPLF: State Crant 10,000 <br />Cash Match 5,000 <br />In -Kinn Match 10,000 <br />TnTAL REVF411F 25,000 <br />'.�xir•ur� <br />Adr+inistrai•i.vr! CrIM-8 15t of 2 x $10,000 (State Grant) <br />15? of 20,p00 <br />$3,000 <br />Page 4-C <br />AUG Q 197 ; <br />�AOK 30 PAGE 352 <br />