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DocuSign Envelope ID: EB541A3B-1E01-49AB-9E09-7987ECAEC1C4 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program Budget <br /> Agency/Program: Garden <br /> C UaK 1". tt:0*d„ a t*Ote4k.F i r->e. er <br /> AGENCY REVENUE ,k201 � l „2l)d5-16 .20.1617, ' <br /> Private Donations $ 200 $ 500 $ 1,000 100% <br /> Agency Generated Revenue(fees) 111111111 0 <br /> Local Government Grants: <br /> Orange County $ 1,000 $ 1 500 $ 1,100 <br /> Town of Chapel Hill $ 1 000 $ 1,500 $ 2,000 33% <br /> Town of Carrboro $ 500 $ 500 $ 1 000 100% <br /> Other Local: -- 0 <br /> Other Local: r 0 <br /> Other Local: - 0 <br /> If more than 3 sources,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way -111111111111111- 0 <br /> State Government -- 0 <br /> Federal Government -11111111111111 r 0 <br /> Other Grants:Z Smith Reynolds MN= $ 1 000 $ 5,000 400% <br /> Other Grants:Strowd Rose $ 2,000 $ 2,000 0% <br /> Miscellaneous/Other Revenue _ 0 <br /> Please list 3 largest MiscellanOus sources: <br /> $ - <br /> $ - <br /> Total Agency Revenue 2 700 7 000 12100 73% <br /> AGENCY EXPENSES <br /> Compensation 0 <br /> Rent&Utilities 0 <br /> Supplies&Equipment �-_ 0 <br /> Travel&Training 111111_ 0 <br /> Other Expenses: <br /> 111111111 0 <br /> Please list 3 largest"Other Expenses": <br /> $ - <br /> $ <br /> Total Agency Expenses 0 <br /> SURPLUS/(DEFICIT)FOR PERIOD: I$ 2,700 I$ 7,000 1$ 12,100 I 73%I <br /> Main Application 2/2/2016 5:09:31 PM Page 27 of 32 <br /> • <br /> • <br />