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GRANT APPLICATION Page 6 of 7 <br />Y <br />141980 BOOK 44 PAGE 328 <br />40ca1 Governmental Unit Applying: <br />(County or City) <br />Delegate Agency Budget - Complete one for each Delegate Agency <br />i <br />program Name: <br />Name of Delegate Agency: <br />Address: Zip: <br />Contact Person: <br />Telephone: ( ) <br />Tax Exempt Number: <br />(if none, attach a copy of the certificate of <br />incorporation) <br />ADMINISTRATIVE EXPENSES CASH IN-KIND <br />1. Salaries <br />2. Rental <br />3. Travel <br />4. Supplies <br />5. Other (specify on attachment) <br />6. TOTAL (lines 1 through S) <br />PROGRAM EXPENSES <br />7. Salaries <br />8. Rental Space <br />9. Travel <br />10. Equipment <br />11. Other (specify on attachment) <br />12. TOTAL (lines 7 through 11) <br />13. TOTAL EXPENSES (line 6 and line 12) <br />Explain by attachment all Linc it:eins <br />over $500. TOTAL BUDGET <br />THE DELEGATE AGENCY HEREBY APPROVES THIS APPLICATION AND t -JILL COMPLY <br />«l'i'lt ALl. PULES, REGULATIONS AND CONTRACTS REE-ATING T11F:i?Fr- <br />APPROVED BY: <br />Pi-,_ai(]ent of Board (.;ignattire) _ <br />`TTESTED BY. <br />Name (Signature) <br />'1'i tle <br />