Orange County NC Website
Browse       Search
DocuSign Envelope ID: CB0C1343-06EB-4BE7-9AF6-62EE77BD69FE t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> PoanityWcgamc Sexual I r ErXratich aicl Outreach <br /> Actual Estimated Pr j d Percent <br /> PA3134CY REVENLE 2314-1 211115-16 946-17 Change <br /> Pri wale MAIM rm $ '1,'1'10 $ 241 0 <br /> Agency Generated Re rrw 0 <br /> Local Gamarinnent C mu ts,. <br /> C1 a Gouty $20,C00 $ 20,CCO $ 20,COO CP• <br /> TONI1cf+0" =1 Hill $ 2,500 $ 2,5C0 $ 2,5C0 090. <br /> Tonin cf Can $ 1,CCO $ 1,030 $ 1,CEO CicY. <br /> C l-le-Local: 0 <br /> al--Local: 0 <br /> al-rsr'-I rr al: 0 <br /> aII <br /> Nan-Local Gawrnmerit Garts <br /> 'I ii,ar Li-itacl'Ably 0 <br /> State C1a rrr r rE 0 <br /> F=ccrary Ga.,g-r-rn-ert 0 <br /> Other CI-arts: : icwO Rases - $ 5,0:1 $ 5,033 CP <br /> ahar C4 ts: F.M.I Hay Fo -dAio $ 5,000 $ '100O3 $ 0,383 <br /> Msc€llarnrnus^'Ctll-rerRevenue -- 0 <br /> Please Het 3 largest MscNlem.,rs ectroes <br /> Taal Agency R€ $28616 38,7141 37,/116 0 <br /> AGENCY EXPENSES <br /> Ocaripiensali cn $2 $ e?} $ 21,543 w"• <br /> Fdert&Lliliti $ ' 4 $ 1,'1 $ 1,183 CP <br /> Supplies&Egilanent $ 1 $ 2,2E5 $ 2,034 <br /> Travel &Training $ $ 2,483 $ 3,040 <br /> C,llh€i Experiseist $ 5,; $ 0,430 $ 0,210 " <br /> Reber 11 et 3largest"Mier na a perise': <br /> FE4ilashr el s $2 pi.2.00 <br /> Inca-i $5X00 <br /> Mac. $ 30O1100 <br /> Total Agency Egarl s $28616 $ 38741 $ 3 EF16 <br /> {I 1C11FCRxPEF4Cet $ - I$ - I$ - I q <br /> Main Application 1/21/2016 18:35:26 a1/p1 II,' age 20 of 2 <br />