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Page 6 of 7 <br />CSTF DELEGATE BUDGET <br />® Complete a separate page 6 of 7 for each delegate (Private non-profit) agency. <br />;AME OF GRANTEE: INDIAN RIVI'R ('OIIMIY -- <br />S !AHE OF DELEGATE: Associatign f,., 11-talod CitLzen,, of Tndinn Rivrr Quinsy, Irv. <br />IAHE OF PROGRAM: Developix nt Training; <br />IDDRESS: Y. 0. Pox 6277 <br />Vero Reach, Florida ZIP CODE: 32961 <br />i <br />„ONTACT PERSON: Jane Pullen <br />rITLE: Executive Director TELEid0n.. '305 231-0342 <br />FEDERAL EMPLOYER ID NUMBER: 59-1626205 <br />(If none, attach a copy of the certification of incorporation) <br />EXPLAIN BY ATTACHMENT ANY LINE ITEM OVER $500 AND ALL ERPENSIS UNDER THE LINE ITEM 'OTHER" <br />(Round off to the nearest whole dollar. Do not include cents). The following line items <br />must correspond to the CSTF Budget Summary Page,(pap 4 of 7). <br />DELEGATE. ADMINISTRATIVE CSTF CASR IN-KIND TOTAL <br />EXPENSES FUNDS MATCH MATCH <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 EXPENSE <br />23. Salaries including <br />fringe benefits <br />24. Rent and Utilities <br />25. Travel <br />26. Other <br />27. Total (Linea 23-26) <br />TOTAL DELEGATE EXPENSES: <br />(Lines 15 + 17) <br />THE DELEGATE AGENCY REMY CERTITIES IT WILL CompLY WM ALL RULES, REGULATIONS AND <br />CONTRACTS RELATING TO THE CSTF GRANT: <br />APPROVED BY: William W. Streeter 11 //1 <br />' <br />(Type Name) l� (Signature) <br />President, Board of Directors <br />(TI�I�) <br />ATTESTED BYt Jane Pullen, Interim Executive Director � _n� G—) A_j <br />(Signature) <br />I <br />3,366.50 <br />1,683.00 <br />5,049.50 <br />1,683.00 <br />1,683.00 <br />3,366.50 <br />1,683.00 <br />1,683.00 <br />6,732.50 <br />3,366.50 <br />1,683.00 <br />1,683.00 <br />6,732.50 <br />THE DELEGATE AGENCY REMY CERTITIES IT WILL CompLY WM ALL RULES, REGULATIONS AND <br />CONTRACTS RELATING TO THE CSTF GRANT: <br />APPROVED BY: William W. Streeter 11 //1 <br />' <br />(Type Name) l� (Signature) <br />President, Board of Directors <br />(TI�I�) <br />ATTESTED BYt Jane Pullen, Interim Executive Director � _n� G—) A_j <br />(Signature) <br />I <br />