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DocuSign Envelope ID: 913F749B-B9E8-4103-AF9D-A4296D01069E t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program Budget <br /> Agency/Progran Ligo Dojo of Budo Karate:Young Warriors Program <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations 1,000 $ 1,089 5 3,000 175% <br /> Agency Generated Revenue (fees) <br /> Local Government Grants; <br /> Orange County 2,000 $ 2,000 $ 2,000 0% <br /> Town of Chapel I-1111 - $ - $ 2,000 0 <br /> Town of Carrboro 2,000 $ 2,000 $ 2,000 0% <br /> Other Local: OC JCPC $ 19,000 $ 19,000 $ 19,000 0% <br /> Other Local: OC match for JCPC 3,600 $ 3,600 $ 3,600 0% <br /> Other Local: 0 <br /> t more than 3 sources,please <br /> provide a separate list <br /> Non-Local Government Grants <br /> Triangle United Way 0 <br /> State Government 0 <br /> Federal Gm.ernment <br /> Other Grants: 0 <br /> Other Grants: <br /> 0 <br /> Miscellaneous/Other Revenue 2,000 5 3,000 $ 4,000 33% <br /> Reese list 3 largest Miscellanous sources; <br /> Wells Fargo $ 1,000.00 <br /> Strowd Roses $ 1,000.00 <br /> Wells Fargo(projected) $ 4,000.00 <br /> Total Agency Revenue $ 29,600 $ 30,689 $ 35,600 ME <br /> AGENCY EXPENSES <br /> Compensation 8,900 $ 14,089 $ 18,000 28% <br /> Rent&Utilities $ 20,700 $ 14,600 5 15,100 3% <br /> Supplies&Equipment 2,000 $ 2,500 25% <br /> Travel &Training 0 <br /> Other Expenses: 0 <br /> Reese list 3 largest"Other Expenses": <br /> $ - <br /> $ - <br /> $ - <br /> Total Agency Expenses $ 29,600 $ 30,689 $ 35,600 16% <br /> SURPLUS/(DEFICIT)FOR PERIOD: I $ J $ - J $ <br /> Main Application 1/25/2016 10:16:09 AM Page 17 of 20 <br />