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GRANT ?PLICATION Page 6 of 7 <br />Local Governmental Unit Applying: TNDTANT RTVFR ('OTJNTY <br />(County or City) <br />Delegate Agency Budget - Complete one for each Delegate agency <br />Program Name: <br />Name of Delegate Agency: VOCATIONAL <br />TRAINING & SHELTERED WORKSHOP IN INDIAN RIVER <br />Address: COUNTY INC. <br />1385. 16th Ave' Vero Beach <br />Zi 32960 <br />P <br />Contact Person: John M. Rezanka <br />Telephone: (305 ) 562-6854 <br />Tax Exempt Number: 59-164-7746 <br />if none, attach a copy of the certificate o <br />incorporation) <br />ADMINISTRATIVE EXPENSES <br />CASH IN-KIND <br />1. Salaries <br />471.00 <br />2. Rental <br />3. Travel <br />4: Supplies <br />5. Other (specify on attachment) <br />6. TOTAL ( lines 1 through 5) <br />471.00 <br />PROGRAM EXPENSES <br />7. Salaries <br />8. Rental Space <br />1573 .25 <br />9. Travel <br />10. Equipment <br />2448.75 <br />11. Other (specify on attachment) <br />1800.00 <br />12. TOTAL (lines 7 through 11) <br />4248.75 1573.25 <br />13. TOTAL EXPENSES ( line 6 and line <br />12) 4719.75 1573.25 <br />Explain by attachment all Line items <br />over $500. <br />TOTAL BUDGET 6239.00 <br />THE DELEGATE AGENCY HEREBY APPROVES <br />THIS APPLICATION AND WILL COMPLY <br />WITH ALL RULES, REGULATIONS AND CONTRACTS RELATING THERETO: <br />APPROVED BY: <br />President of Board <br />ATTESTED BY: John M. Rezanka <br />Name <br />Executive Director <br />Title <br />AUG 131980 <br />(Signature) <br />RQOK 44 FacF,266 <br />C�-51s <br />