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AUG -5 1981 — Book 47 PAcE 9 <br />Local Governmental Unit Applying: INDIAN RIVER COUNTY <br />(County or City) <br />* This page applicable only to private non-profit delegate agencie$ <br />Complete a separate page 6 for each delegate agency provider <br />Program Name: Indian River. County Council on Aging, Inc. <br />Name of Delegate Agency: Indian Ri var Ch mt Counr•i 1 on Agi ag, Inc _ <br />Address:- 955 7th Avenue, Vero Beach, Florida 32960 <br />Contact Person: Judith N. Welchel <br />Telephone: ( 305 ) 5697-0760 <br />Tax Exempt Number: 06-00180-00-41 <br />(if none, attach a copy of the certificate of <br />incorporation) <br />ADMINISTRATIVE EXPENSES CASH TN-XTUn <br />1. Salaries <br />2. Rental <br />3. Travel <br />4. Supplies <br />S. 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. Other (specify on attachment) <br />12. TOTAL ( lines 7 through 11) <br />-0- <br />4,719.75 1,573.25 <br />4,719.75 1,573.25 <br />13. TOTAL EXPENSES (line 6 and line 12) 4,719.75 <br />1,573.25 <br />TOTAL BUDGET . 6 , 293.00 <br />THE DELEGATE AGENCY HEREBY APPROVES THIS APPLICATION AND WILL COMPLY <br />WITH ALL RULES, REGULATIONS AND CONTRACTS RELATING THERETO: <br />APPROVED BY • F. Eugene Cragg /10 <br />President of Board { iggatur-a-Pi <br />Judith N. Welchel ' <br />ATTESTED BY: <br />Name Executive Director (,Signature) <br />Title <br />EXPLAIN BY ATTACHMENT ANY LINE ITEM OVER $500. <br />_I <br />y�•y <br />