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of Applicant:_- i_.__—__•1114I>tL1iIYI:fil:(Itlrl.TY_—.__ <br />(City or county) <br />TOTAL BUDGET <br />Include figures from all delegate agency budgets. <br />I. Explain by attachment all expenditures over $500 per line item. <br />cash match must be at least one half: of state grant requested. <br />„.D, The cash and in-kind match combined must equal the state Urant. <br />REVENUE <br />1 - <br />State Grant <br />3146.50 w <br />2. <br />C"b 001CII (a9 fcdcl;al IDI)ds.. Eh -CSAR <br />10Y2nue sbariDJ, <br />allowed) <br />1573.25 <br />3. <br />In -hind Match <br />-- <br />1573.25 <br />.1 • <br />TOTAL BEYENUE <br />!,_ .00 <br />(_RANTEP ADMINISTRATIVE EXPENSE <br />CASH <br />IN-KIND <br />— <br />— <br />5. <br />Salaries <br />14712.75 <br />-" <br />6. <br />Rental Space <br />— <br />- <br />7. <br />Travel <br />-- <br />8, <br />Supplies—_ <br />- <br />9. <br />Uther (specify on attachment) <br />�--- <br />10. <br />TOTAL ( Line:; 5 through 9 <br />DEI.::GATE ADMINISTRATIVE EXPENSE <br />11. <br />Salaries <br />-0- <br />_r1 <br />L2. <br />Rental Soace <br />— — <br />------- <br />13. <br />T i -,t :, e 1 <br />-- - <br />---- -- <br />-- -- <br />14. <br />Su)plies <br />15. <br />Ot}],:_r (specify on attachment) <br />--- <br />--- <br />lu. <br />TOTAL (lines 11 through 16) <br />t 17 . <br />T.)TAL •ADI•IINIS`I'RATIVE EXPEI'ISES <br />_r - <br />line 10 and 16) <br />*Line 17 must not exceed <br />15% of <br />two times Line <br />1. <br />G11A:;TEE PR0GP-*k,,1 EXI'1SI45IE <br />18. <br />salaries <br />1.9. <br />Rental <br />-------- <br />20. <br />Travel <br />--- - <br />-------..._____ <br />21. <br />Equipment <br />----- <br />2'1,. <br />Ott],�r (specify on attachment) <br />-_--_ --' <br />--------- <br />23. <br />TOTAL (lines 18 through 22) <br />`--`- <br />-- <br />-- <br />DELIEGATP•. PROGRAM EXPENSE <br />24. <br />Salaries <br />25, <br />Rental Space>f:%._'_`•--__---- <br />26. <br />Travel <br />— <br />— <br />27 . <br />Equipment <br />--- <br />28. <br />Ot)]er (specify on attachment) <br />- - <br />2!1, <br />'1'l)'1'a[, (1111('-:: 2 4 thrVU'J)] 211) <br />_ <br />/�'� r�, i�—____ <br />----•----------- <br />30. <br />1'l!'i'AL PRUGIUIM L••,:PEN!,*ES (liner; 1.3 and <br />_ — - ..._ <br />47 <br />1 . <br />rc'r:,L h::PPI1nr.'rnrr'::; 1. i na 17 .unl 30) <br />32. <br />OTAL CUL1:11NED EXPENDITURES (Cash and <br />-. •- <br />' in -Kind) <br />�-'U`— <br />(Line 32 should equal line )) <br />_(,43 <br />