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40 <br />• <br />GRANT APPLICATION Page 6 of 7 <br />,ocal Governmental Unit Applying: Indian River County Commission <br />ruw; , comity, or cICYT- <br />.CONTRACTIIAT, INFORMATTON - Complete one for each Deleqate Agency <br />General <br />Name of. Deleaate Anency: Vero Beech YMCA <br />Address: 3705 16th Street, Vero Beach, Fla. 32960 <br />Contact Person: Terrence D. Marr <br />Telephone: (10 ) 562-9 or 562 9037 — I <br />Tax Exempt Number.* 59-1321565 = Fed.# 05-00162-00-41 =State # <br />*If none, attach a copy of the certificate of incorporation <br />DELEGATE AGENCY BIIDGFT FOR THIS PROGRAM <br />ADMINISTPATTIIF FXPFNSFS <br />1. Salaries ___1 Secrg-t4ry-______---___ $ -5-0a,00- <br />2. Rental _Space _____________________ <br />3. Travel ----------------------- -- <br />9. -,unpliPs _------- - -_ - - <br />, -- <br />5. Other (:enc ci.fy_attachment) - - - _ - - - - - - - - --- <br />6. *mOm'�L Tli.nes_1_thrnunh_5) _ _ _ _ _ _ _ _ _ - - - _ - 600.00 <br />PRO( -,RAM T'YPFNSFS <br />7. <br />Salaries -4 -Instructors, 1 Maintenance, 1 Playground_ - 3,100.00 <br />8. Rental_Snare---------------- - - - - - <br />— <br />9. Travel. _------------------------�+95.6(i <br />10. F:auiipme nt _ <br />71 <br />11. Ether Tspecifv-on attachment) <br />12.. TOTAL Tlines_7-thr0ugh-lI)__ - - - - _ - - - __ _ - - - <br />1.3. TOTAL EXPENSES -(line-6_and_line 12) _ _ _ _ _ _ _ _ _ 4,195.00 <br />*May not exceed 15% of line 13. <br />THE DRLrGATF Arr"ICY HEPFgy APPROVES THIS APPLICATTON AND WILL COMPLY <br />1 -11TH ALL RULES, PFGIILATJONS AND CONTRACTS RELATING THERETO: <br />AnPR,nvFD Pv: Di.rector, YMCA <br />('j,itl(-) <br />tic <br />Signature) <br />5tgn:cture'- <br />1 <br />