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GRANT APPLICATION Page 6 of 7 <br />Local novernmental Unit Applyincr: Indian River County Commission <br />town, county, or city <br />13.CONTRACTTTAL TNFbRMATTt1N - Complete. one for each Delegate Agency <br />General <br />Mame of. Deleaate Acrencv: Vero Beach YMCA <br />Address: 3705 16th st. Vero Beach, Fla. 32960 <br />Contact Person: Terrence D. Marr <br />Telephone: _(305 ) 562-9037 <br />Tax Exempt Numher: * 05-00162-00-41 <br />*If none, -attach a copy of the certificate of incorporation <br />DELEGATE AnENCY BUDGET FOR THIS PROGRAM <br />ADMINISTRATIVE FXPFNSFS <br />1. Salaries1100 in kind 16 hrs. at 3 1139.00 <br />2. Rental-STace- _ _------------------ <br />3. Travel- ---------_ -.----------- 4 <br />0. <br />4. RuEpli;s-- --- -- ----- .------- <br />5. Other (specify on attachment) - - - - - - p� <br />6. *?'OTAL (lines-1^throu_________________ 1205.00 <br />PROCPAM FXPFNSPS <br />7. Salaries _ _ _ _ _ 2000 in kind 5600.00 <br />8'. Dental S-aace_ _ _ _ _ _ -_ _ _ _ - - - - - - - 1500.00 <br />9: Travel- ----------_- __------ 365.00 <br />10. FouiFment _ - - - - - 425.00 <br />11. Other (speci___v_on attachment_] - - - - - - - - •-- - 200.00 <br />12. TOTAL (lines 7 tFirouoh 11.) - - - - - - _ _ _ _ _ 8090.00 <br />13. TOTAL EXPFNSE.S-(line-6-and-line 12) - - - - - - - - - 9295.00 <br />�Mav not exceed 15% of line 13. <br />THE DRLFGI+TF. Arr ICY HEREBY APPROVES THIS APPLICATION AND ]JILL COMPLY <br />'KITH ALL QTILFS, VFC-TTLATTONS AND CONTRACTS RELATING THERETO: <br />hPVVnt1FD nv: Exec. Director YMCA <br />(Title) Signature) <br />ATTESTPD Rv: Administrative Secretary <br />Title S.io a�ture <br />Page 6-C <br />' s • <br />I <br />