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GRANT APPLICATION Page 6 of 7 <br />i Local novernmentai Unit Applyinu: Indian River County Commission <br />town, county, or, city <br />13-CONTRACTTIAL 7NFOP_MATInN - Complete one for each Delevate AcTency <br />General <br />Name of. Deleaate Aaencv: Vero Beach YMCA, Inc. <br />Address: 3705 16th Street, Vero Beach, Florida 32960 <br />Contact Person: Terrence D. Marr <br />Telephone: ( 305) 562-9037 <br />Tax Exempt Number:* 05-00162-00-41 <br />*If none, attach a copy of the certificate of incorporat'_ <br />DELEGATE AGENCY BUDGET FOR TRIS PROGRAM <br />ADMINISTRATIVE FXPFNSFS <br />1. Salaries— <br />_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 792. nO in k, nd <br />2. Rental—G---------------—______ <br />3. Travel ` <br />--------------------- <br />4. Supplies ------.------ <br />S. ether Tsjecifye_on attachment) _ _ _ _ _ _ _ _ _ _ _ _ <br />6. *;FbTAL Zlrns_1_throuah_5T _ _ _ _ _ _ _ _ _ _ _ _ _ 792.00 in k=nd <br />PROOPAM FXPFNSFS <br />3,456.00 in kind <br />9. Salaries_____________________ 4,320.00 <br />8. Dental Space_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1,520.00 i n nd <br />9. Travel ----------------------- ' <br />10. Equipment — <br />200.00 <br />11. OtFier Tspecify on attachmentf _ _ _ _ _ _ _ _ _ _ , <br />12. TOTAL TlinEPEE <br />es_7_tfirouah_lT)_ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />13. TOTAL EXPENSES—(line_6—and_line 12) _ — _ — _ _ _ _ _ 19,288.00 <br />*Mav not exceed 15% of line 13. <br />THE DFL.FGA.TF. AGF.*ICY iIERF.BY'APPROVFS THIS APPLICATION AND WILL COMPLY <br />KITH ALL PTTLFS, PFGTILAT:rONS AND CONTRACTS RELATING THERETO: <br />APPPnvFD Fav:. Executive Director 'w <br />(Title) Signature) <br />ATTESTrn nv: Secretary ' <br />Title) (Siandture) <br />4 <br />Page 6-C <br />AUG101977 ops 30 oAGE 54 <br />