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Application for Immunization l~mxi-Grant Funds <br />Deadline for submission: Mmy 26, 1995 <br /> <br /> Date l~:eived: <br />(c~pl~t,:~! ~ lmmuniz~oa 8eclion) <br /> <br />Project Name: I~nmun£zation Hin:t-Grant Funds <br /> <br />2. Health Department Name: Cabacrus County <br /> <br />Contact Name: Capitola Stauley <br /> <br />:3. Full Address: <br /> <br />P 0 Box 1149 <br />715 Cabarrus Avenue, West <br />Concord NC 28026-1149 <br /> <br />Phone Number: (704) 786-8121 <br />Fax Number: (704) 786-4955. <br /> <br />5. Project Budget (include brief descriptions of itemized expenditures) <br /> <br />A. Itemized Expendituma: <br /> <br />Personnel - Salary/Fringe <br /> <br />$ 20,813.43 <br /> <br /> Operating ]Expenses $ 300. o0 <br /> Supplies and Materials $ <br /> <br /> Other Expenses $ <br /> <br /> T°tal Expenditures $ 21:1 lq.&q _ <br />B. Kevenue <br /> Total funds requested from the Immunization Section $ 21,113.43 <br /> Other Project Funds * $ <br /> <br /> Total Revenue $ 21,113.43 <br /> <br />* Indicate source and amount of all other funds secured for this project. <br /> <br /> <br />