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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/Prograrr Garden <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Chan.e <br /> Private Donations $ 200 $ 500 $ 1,000 100% <br /> Agency Generated Revenue (fees) --- 0 <br /> Local Government Grants: <br /> Orange County $ 1,000 $ 1,500 $ 2,000 33% <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: --- 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 --- 0 <br /> State Government --- 0 <br /> Federal Govemment --- 0 <br /> Other Grants:Z Smith Reynolds $ - $ 1,000 $ 5,000 400% <br /> Other Grants:Strowd Rose - $ 2,000 $ 2,000 0% <br /> Miscellaneous/Other Revenue <br /> Please list 3 largest Miscellanous sources: <br /> $ - <br /> $ - <br /> Total Agency Revenue 2 700 7 000 13 000 <br /> AGENCY EXPENSES <br /> Compensation --- 0 <br /> Rent&Utilities _-_ 0 <br /> Supplies&Equipment -_ 0 <br /> Travel&Training 0 <br /> Other Expenses: _-_ 0 <br /> Please list 3 largest"Other Expenses": <br /> $ - <br /> $ <br /> Total Agency Expenses M1111.111111.11111 0 <br /> SURPLUS/(DEFICIT)FOR PERIOD: $ 2,700 I $ 7,000 I $ 13,000 I 86% <br /> Main Application1/25/2016P age 26 0 f 32 <br />