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C <br />Page 4f <br />CSTF DELEGATE BUDGET <br />Complete a separate page 6 of 7 for each delegate (Private non-profit) agency. <br />WE OF GRANTEE: <br />IM OF DELEGATE: Indian Rlyer county COuncil on Aging, Inc._ <br />TAME OF PROGRAM: Service Coordination <br />%DDRESS: 686 14th Street, P. 0. Box 2102 <br />32961 <br />Vero Beach, Florida ZIP CODE: <br />ZONTACT PERSON: Arlene S. Fletcher <br />IITLE: <br />Executive Director TELEPHONE: 305 569-0760 <br />FEDERAL EMPLOYER ID NUMBER: 59-1539957 <br />(If none, attach a copy of the certification of incorporation) <br />. ......... R..... <br />EXPLAIN BY ATTACHMENT ANY LINE ITEM OVER $500 AND ALL EA'ENSES UNDER TIM LINE ITEM 'OTHER". <br />(Round off to the nearest wbole dollar. Do not include 4 efts). The following line item <br />must correspond to the CSTF Budget Summary Page,(page <br />DELEGATE ADMINISTRATIVE CSTF CASH IN -RIND TOTAL <br />EXPENSES FUNDS MATCH HATCH <br />11. Salaries including <br />fringe benefits <br />12. Rent and Utilities <br />13. Travel <br />14. Other <br />15. Total (Lines 11-14) <br />DELEGATE PROGRAM EXPENSI <br />23. Salaries including <br />fringe benefits <br />24. Rent and Utilities <br />25. Travel <br />26. Other <br />27. Total (Lines 23-2f <br />TOTAL DELEGATE EXPENSE: <br />(Lines 15 + 17) <br />r <br />3066,50 1 83.00 1 683.00 6 732.50 <br />3 66.50 1 83.00 1,683.00 6 732.50 <br />3,366.50 1,683.00 1,683.00 6,732.50 <br />THE DELEGATE AGENCY HEREB2 CWTPIE6 IT WILL 00"PLY WITS ALL RALES, REGULATIONS AND <br />CONTRACTS RELATING t0 THE CSTF GRANT: 7 <br />APPROVED BY: Dora L. Anderson 126 <br />(Type Name) Signature) <br />President, Board of Directors <br />(Title) <br />,ATTVeTPn av: ArlenF3 r1: Fletchor, Executive Director�.� <br />A4l <br />