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Name olicant: !NDIAN RIV7R COUN i I <br />ft (Ci%TEW Cc..:nty ) <br />TOTAL BUDGET <br />A. Include figures from all delegate agency budgets. <br />B. Explain by attachment all expenditures over $500 per line item. <br />C. Cash match must be at least one half of state grant requested. <br />D. The cash and in-kind match combined must equal the state grant. <br />REVENUE <br />1. <br />State Grant <br />3146.50 <br />2. <br />CAZb Matgb (D2 12dP-X31 92W991 <br />S2YgD1dy ahariDg, <br />allgwed) 1573.25 <br />3. <br />In -Kind Match <br />1573.25 <br />4. <br />TOM BEVENDS <br />6293.50 <br />GRANTEE ADMINISTRATIVE EXPENSE <br />CASH <br />IN-KIND <br />5. <br />Salaries <br />6. <br />Rental Space <br />7. <br />Travel <br />8. <br />Supplies <br />' <br />9. <br />Other (specify on attachment) <br />10. <br />TOTAL (lines 5 through 9 ) <br />DELEGATE ADMINISTRATIVE EXPENSE <br />11. <br />Salaries <br />471.00 <br />12. <br />Rental Space <br />13. <br />Travel <br />14. <br />Supplies <br />15. <br />Other (specify on attachment) <br />16. <br />TOTAL (lines 11 through 16) <br />471.00 <br />*17. <br />TOTAL ADMINISTRATIVE EXPENSES <br />471.00 <br />- <br />(line 10 and 16) <br />*Line 17 must not exceed 15% of <br />two times line <br />1. <br />GRANTEE PROGRAM EXPENSE <br />18. <br />Salaries <br />19. <br />Rental Space <br />20. <br />Travel <br />21. <br />Equipment <br />22. <br />Other (specify on attachment) <br />23. <br />TOTAL (lines 18 through 22) <br />DELEGATE PROGRAM EXPENSE <br />24. <br />Salaries <br />471.00 <br />25. <br />Dental S- ace <br />- <br />26. <br />Travel <br />- <br />27. <br />Equipment <br />2448.75 <br />28. <br />Other (specify on attachment) <br />1805.00 <br />29. <br />TOTAL (lines 24 through 28) <br />4719.75 <br />1573.25 <br />30. <br />TOTAL PROGRAM EXPENSES (lines 23 and <br />29) <br />4719.75 <br />1573.25 <br />31. <br />TOTAL EXPENDITURES (line 17 and 30) <br />4719.75 <br />1573.25 <br />32. <br />TOTAL COMBINED EXPENDITURES (Cash and <br />in -Kind) <br />6293.00 <br />(line 32 should equal line 4) <br />AUG 13'1980 <br />I BOOK 4.4 PAGE ZS4 � � <br />