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*• <br />40 <br />ORA14T NAME: � � tirG[1lJ <br />GRANT A <br />AMOUNT Op GRANT: L 'IC[ <br />Ol 1.12 <br />Ra lar Salaries <br />R5,477 <br />DEPARTMENT RECEIVING GRANT;{{__ <br />Other Salaries & Wages PT <br />CDNTACTPERSDN: �rL` �Y11 ' &t PHONE NUMBER! <br />012A 1 <br />� <br />Starting Date: IG A GC' <br />1. How kng is the putt for? <br />I Retwerrmm-Contributions <br />2. Dots the pans rtciuim you w frad this fuwuuu aAer the grant is ever? <br />Yes No <br />3. Does the gruN require e match?— <br />If yea, does the pant allow the match to be in In Kind Sevicea? <br />Yes 2! No <br />Yes _No <br />4. Percentage of match to pant <br />Workeds CompreQN <br />S. Grant match aroo mt required S <br />012.17 <br />6. Where are the matching fords owning from f i -e In ki�+d Serv�i� ��. Contingency) <br />�� <br />7. Docs the grant cover capital costs or start-up coats?? <br />Yes JLN. <br />if no, how much do you think will be ne&W in capital costs or start up costs? <br />(Attach o dcWl luting of costs) <br />8. Art you adding arty additional positions utilizing the grant funds? <br />Yes No <br />If yes, Please list gf additional Space is nae" pkaw attach a schedule.) <br />Acta. <br />Description <br />Position Position Position Posidoo Position <br />Ol 1.12 <br />Ra lar Salaries <br />R5,477 <br />011.13 <br />Other Salaries & Wages PT <br />012A 1 <br />Social Sectrri -i- T <br />412.12 <br />I Retwerrmm-Contributions <br />I 3 <br />412.13 <br />trtstman .ureR ucalth <br />7 - <br />012.14 <br />Workeds CompreQN <br />012.17 <br />3 <br />9. What is the total cast of each Position including benefits, capital, start-up, auto expestse, travel and operating? <br />Salary and Benefits <br />Operating COILS Capital <br />Total Coo <br />10. What is the estimated coat of the grant to the county ever five years? j <br />-i' <br />V)(<4(c( <br />c Cj <br />�1) <br />LLVJJLLL111 <br />Signature of Prep.,. -7—_ 3 Date: t k�1L <br />�t� l Res <br />Odor Match Casts <br />_NotCoverod MAO Total <br />F <br />irstJ s "t7'- S Lt 1 <br />S T S C <r <br />S $ S 'L[ tf t <br />Fourth Ytar $ <br />S Z`� <br />f <br />S' I- o i'�CJ <br />-i' <br />V)(<4(c( <br />c Cj <br />�1) <br />LLVJJLLL111 <br />Signature of Prep.,. -7—_ 3 Date: t k�1L <br />�t� l Res <br />Odor Match Casts <br />_NotCoverod MAO Total <br />F <br />irstJ s "t7'- S Lt 1 <br />S T S C <r <br />S $ S 'L[ tf t <br />Fourth Ytar $ <br />