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Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : App. #1 , Whiteface Acres Address : 14150 11 Place S . W. Vero Beach , Fl . 32978 Tract Number(s) : Field Number(s) : 4-Jan Date : Nov. 16 , 2002 Vl:-;Revievv°Surfim : . 4 Land Use/Field : Acres . Micro-Irrigated Citrus Grove 158 Best Management Practices Applied For: 2. Install 7 FBR H2o Control Structures. Total SM P Costs : j 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: $ 12 , 004 ` $9, 003 175 51 . 45 $3 , 001 . Vtl: Rematke: .., VIM. DeeignaWd Conservationist: `< , /Opr/ (Signature) Date: (Checked By) Date: IRSWCD r roval Date ( PPlican Date Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U .S . C . 522a) . The authorities for requesting the information to be applied on this form are: 16 U .S .C . 590a-f (Soil and Water Conversation) ; 16U .S .C . 3801 et seq . (Food Security Acto of 1985, as ammended) , and the regulation promulgated theruder. The information requested is necessary for the evaluation of an application, development and implementation of a conservation plan as the basis for satisfying program eligibility and compliance requirements , and for providing technical education , or financial assist- ance under the previously mentioned authorities . Furnishing this information is voluntary; however, failure to fumish correct, complete information will result in the withholding or withdrawal of such technical, educational, or financial assistance. This information may be furnished to other USDA agencies , the Internal Revenue Service, the Department of Justice, or the other State or Federal law enforcement agencies , or in response to orders of a court, magistrate, or administrative unal. Page 3 IRSWCD ( 10-26-01 )