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Past Actual 3 <br />LTAC Grant $10,000.00 <br />Funding <br />All Other Revenues <br />Account Name Past Actual 3 <br />Fund raising $ 24295.39 <br />In-Kind Contributions <br />Account Name <br />Revenue Totals <br />Expenses <br />Account Name <br />Exhibit Expense <br />Expense Totals <br />Profit & Loss <br />Past Actual 3 <br />$ 25000.00 <br />Past Actual 3 <br />$ 59295.39 <br />Past Actual 3 <br />$ 15498.34 <br />Past Actual 3 <br />$ 15498.34 <br />Past Actual 3 <br />$ 43797.05 <br />Past Actual 2 <br />$ 7,200.00 <br />Past Actual 2 <br />$ 25198.16 <br />Past Actual 2 <br />$ 26160.00 <br />Past Actual 2 <br />$ 58558.16 <br />Past Actual 2 <br />$ 15680.83 <br />Past Actual 2 <br />$ 15680.83 <br />Past Actual 2 <br />$ 42877.33 <br />Past Actual 1 <br />$ 9,500.00 <br />Past Actual 1 <br />$ 21037.40 <br />Past Actual 1 <br />$ 17660.00 <br />Past Actual 1 <br />$ 48197.40 <br />Past Actual 1 <br />$ 19215.27 <br />Past Actual 1 <br />$ 19215.27 <br />Past Actual 1 <br />$ 28982.13 <br />Projected <br />$ -12,000.00 <br />Projected <br />$ 25000.00 <br />Projected <br />$ 20000.00 <br />Projected <br />$ 33000.00 <br />Projected <br />$ 20000.00 <br />Projected <br />$ 20000.00 <br />Projected <br />$ 13000.00 <br />Application Certification ~ ------------------~------------- <br />The applicant here certifies and affirms: 1. That it does not now, nor will it during the performance of any contract arising <br />from this application, unlawfully discriminate against any employee, applicant for employment, client, customer, or other <br />person who might benefit from said contract, by reason of age, race, color, ethnicity, sex, religion, military status, sexual <br />orientation, creed, place of birth, or disability; 2. That it will abide by all relevant local, state and federal laws and <br />regulations and; 3. That it has read the information contained in the Instructions on pages 1 and 2 and understands and <br />will comply with all provisions thereof. <br />Certified by:* <br />Name* Phil Backlund <br />Applicant's Title* Board Immediate Past President