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9129122, 10:54 AM <br />Retail <br />Supplies <br />Taxes <br />Tel/ lnternet <br />Utilities <br />Web <br />Volunteer time offset <br />Grant Exp <br />Expense Totals <br />Profit & Loss <br />Certified by: <br />Name* <br />$ 2465.04 <br />$ 8742.70 <br />$ 3012.03 <br />$ 5364.98 <br />$ 10076.96 <br />$ 214.89 <br />$ 55318.88 <br />$ 50630.54 <br />Past Actual 3 <br />$ 451525.10 <br />Past Actual 3 <br />$ 2169.88 <br />$ 2953.47 <br />$ 8729.42 <br />$ 3551.37 <br />$ 5169.26 <br />$ 13688.06 <br />$ 389.31 <br />$ 55318.88 <br />$ 12986.24 <br />Past Actual 2 <br />$ 495234.37 <br />Past Actual 2 <br />$ 152681.30 <br />LTAC Clerk Review <br />$ 3250.00 <br />$ 6000.00 <br />$ 3620.00 <br />$ 5250.00 <br />$ 13500.00 <br />$ 500.00 <br />$ 55318.88 <br />$ 19713.32 <br />Past Actual 1 <br />$ 567968 20 <br />Past Actual 1 <br />$ -34881.83 <br />$ 3250.00 <br />$ 6000.00 <br />$ 3620.00 <br />$ 5250 00 <br />$ 13500.00 <br />$ 500.00 <br />$ 55318.88 <br />$ 40000.00 <br />Projected <br />$ 588254.88 <br />Projected <br />$ 19072.00 <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 <br />arising from this application, unlawfully discriminate against any employee, applicant for employment, client, customer, <br />or other person who might benefit from said contract, by reason of age, race, color, ethnicity, sex, religion, military <br />status, sexual orientation, creed, place of birth, or disability; 2. That it will abide by all relevant local, state and federal <br />lawsandregulationsand; 3.Thatithasreadtheinformationcontainedinthelnstructionsonpages land2and <br />understands and will comply with all provisions thereof. <br />Sign <br />Monica Miller <br />Applicant'sTitle* ExecutiveDirector <br />lf-app-16-03.co.kiftitas.wa.us/Forms/form/submission/history/77511185646?hideHeader=true 15t15