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GRANT APPLICATION Page 6 of -7 - <br />0cal Governmental Unit Applying: <br />— -- (County or City)_._... <br />Delegate Agency Budget - Complete one for each Delegate Agency <br />Program Name: <br />Name of Delegate Agency: <br />Address: Zip: <br />Contact Person: <br />Telephone: ( ) <br />Tax Exempt Number: <br />if none, attach a copy of the certificate of� <br />incorporation) <br />ADMINISTRATIVE EXPENSES CASH IN-KIND <br />1. Salaries <br />2. Rental <br />3. Travel <br />4. Supplies <br />5. Other (specify on attachment) <br />G. TOTAL (lines 1 through 5) <br />PROGRAM EXPENSES <br />7. Salaries <br />S. Rental Space <br />9. rravel <br />1.0. Equipment <br />11. Other (specify on attachment) <br />12. TOTAL (lines 7 through 11) <br />13. TOTAL, EXPENSES (line 6 and line 12) <br />Explain by attachment all Linn <br />over $500. TOTAL BUDGET <br />THE DELEGATE AGENCY HEREBY APPROVES THIS APPLICATION AND WILL COMPLY <br />WITH ALL RULES, RLGUf.,ATIONS AND C014 TRACT REI.ATMG 'fHE:I�r''r• <br />APPROVED BY: <br />Pi :�i lent of Ruard (Signature) - - <br />ATTESTED D BY: <br />Name <br />1'i tle <br />Signature <br />