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--- •.•. "r rr a jC v v.. r <br />'AUG 5 19 1 <br />BOOff 4 7 PAGE 84 <br />Local Governmental Unit Applying: INDIAN RIVER COUNTY <br />(County or City) <br />* This page applicable only to private non-profit delegate agencies <br />Complete a separate page 6 for each delegate agency provider <br />Program Name: Developmental - Training <br />Name of Delegate Agency: Vocational Training And Sheltered Workshop In Indian <br />River County, Inc. <br />Address • 1385 16th Ave, Vero Beach, Fla 32960 <br />Contact Person: John A1. Rezanka <br />Telephone: ( 305 ) 562-6854 <br />Tax Exempt Number: 59-164-7746 <br />i none, attach a copy of the certificate of <br />incorporation) <br />ADMINISTRATIVE EXPENSES <br />1. Salaries <br />2. Rental <br />3. Travel <br />4. Supplies <br />5. Other (specify on attachment) <br />6. TOTAL (lines 1 through 5) <br />PROGRAM! EXPENSES <br />7. Salaries <br />8. Rental Space <br />9. Travel <br />10. Equipment <br />11. <br />Other <br />(specify <br />on attachment) <br />12. <br />TOTAL <br />( lines 7 <br />through 11) <br />CASH <br />461.25 <br />2351.25 <br />1800.00 <br />4612.50 <br />13. TOTAL EXPENSES ( line 6 and line 12 ) 4612.50 <br />IN-KIND <br />1537.50 <br />1537.50 <br />TOTAL BUDGET 6150.00 <br />THE DELEGATE AGENCY HEREBY APPROVES THIS APPLICATION AND WILL COMPLY <br />WITH ALL RULES, REGULATIONS AND CONTRACTS RELAT NG THERETO: <br />APPROVED BY: R.E. Arendas � <br />President of Board (Sig <br />ATTESTED BY: John M. Rezanka <br />�4' <br />Name John <br />Executive Director <br />Title <br />EXPLAIN BY ATTACHMENT ANY LINE ITEM OVER $500. <br />v -I = 0 <br />