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GRANT APPLICATION Page 4 of 7 <br />Name of. Applicant: Indian River County Commission <br />Fiscal Officer Responsihle for Grant: <br />Name: Mr. William Jackson Finance Officer <br />Address: County Courthouse 2145 <br />Telephone: L1a 562_7927 <br />11. TOTAL BUDGET <br />(Include fiqures from all programs operated) <br />I. REVENUE <br />I. State Grant4130.00 <br />__ _ _ ___________'__ <br />2. Cash Tlatcl1_(no federal_fcinds, exSept_rG,yequ�sharinr,aJlnwpd)... 2065.00 <br />3. In -Kind Match 3100.00 <br />4. TO"'AL nrv------------ - - - - -- ---- 9295.00 <br />rRANTEF ADMTNTSTPATTVF EXPFNSF <br />5. Salaries _ __ ____ ___________ 0 <br />6. Arntal SLacc'_______________ ______ <br />7. Travei_ <br />R. Sl1n!"nI ie5- - - - - - - - - - - - - - - - - - - - - - <br />9. Other Tsrecifv-on attachment) - - - - - - - <br />10. Total (lines 5-throuah 9) - - - - - - - - - - - - <br />DELEGATE AWITNISTRATIVE FX.PF"lSF <br />11. Salaries 1100 in kind 1,139.00 <br />12. Rental -_Space ----------------------U__ <br />13. Travel � <br />`---------------------- <br />14. Supnlies------------------------ <br />15. 50,-er (specify on attachment) _ - _ _ -_ _- - -_ <br />16. Total (_lines 11 through 16) - _ _ _ _ - -_ _ _ 1,205.00 <br />17. TOTAL Al)t-iI; IF;TRATIVI:-COSTS* (Line 10 -and -Line 16) - -{i 1,205.00 <br />GRANTFF PR,')gRAM EXPENSE <br />18. <br />Salaries_ <br />0 <br />19. <br />_ <br />Rental Space - - - - - - - - - - <br />- - - - - - - - - - <br />- 0 <br />20. <br />Travel-�------------ <br />---------- <br />0 <br />21. <br />I:crui-v Tent ---------------------- <br />0 <br />22. <br />Other (snecifv on atY.achment) - <br />- - --- - <br />- 0 <br />23. <br />_ <br />Total 71ir.cs 1R throunh 22) <br />_ _ _ ___ _ _ _ <br />_ <br />0 <br />Drl,L'r,ATF PPOr;"AN4 FXPENSF <br />24. <br />Salaries <br />2000 in kind <br />25. <br />_ <br />pental Sna Cr°- - - - - - - - - <br />- - - - - - - - - - <br />-'--- -5,,6�0c00..70,0 <br />26. <br />Tr..avc,l------------------------ <br />365.00 <br />27.T?�L.iinnent <br />---_-_--_-_--_-_-_-__--__--_-_-__-_-_-_ <br />425.00 <br />7.R. <br />ntT e . (sLec.i fv on attachment) _ <br />_ - - - _ - _ - <br />- 200.00 <br />29 . <br />- - <br />h 2 <br />'Fotal (lines_24 throuca8) - - - - - - - - - - - - <br />3'%. <br />TO -Al, PTY)r;Rnt•+ T"MT-11ST'S, ([.in(,. -23 <br />and line 29) <br />8,090.00 <br />31. <br />TOTAL EM"1niTUPYS, (Linc 17 and <br />].ine 30) <br />9,295.00 <br />gr?TE: TOTAL. 1'1iVENUF MUST EQUAL <br />TOTAL EXPENDITURES <br />*''ay not excood 151Y, of 2 tines the state grant <br />FXAM111,1e: State Grant: <br />10,000 <br />Cash Match <br />5,000 <br />In -Kind Mitch <br />10,n00 <br />TOTAT, 1'•l:Vli^1115 <br />25,(06 <br />°axirnrT <br />P•dmi.ni.;:trati.vo Cnsts - 15?. of <br />2 x $10,000 (St,Ti:r. <br />(;rant) <br />159. ref <br />20,000 <br />$3,000 <br />