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DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION Approved 9.1.2016 <br /> 2nd Total Annual <br /> HHC Approved Budget 2016-2017 1st Quarter Quarter 3rd Quarter 4th Quarter Budget <br /> Income <br /> Book Sales 150 00 150.00 150.00 150.00 600.00 <br /> Contributions 150,00 6,000,00 150,00 150,00 6,450 00 <br /> Auction <br /> 35,000 00 3500000 <br /> Program Fees 150.00 150.00 150.00 150.00 600.00 <br /> Other Income 200.00 200.00 200.00 200.00 800.00 <br /> Total Non-Grant Income 650.00 6,500 00 650.00 35,650 00 43,450.00 <br /> Grant Income <br /> FM Kirby Foundation 1,875.00' 1,875 00 1,875.00 1,875 00 7,500.00 <br /> Orange County Human Services 2,214 25 2,214.25 2,214 25 2,214 25 8,857.00 <br /> Town of Hboro Tourism Bd 5,196 75 5,196.75 5,196 75 5,196 75 20,787.00 <br /> Other Grant Income <br /> Total Grant Income 9,286.00 9,286 00 9,286.00 9,286 00 37.144 00 <br /> Total home 9,936 00 15,786 00 9,936 00 44,936.00 80,594 00 <br /> 01 <br />