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Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : Appl #1 Whiteface Acres Address : 14150 11th Place S .W. Vero Beach , FI . 32968 Tract Number(s) : Field Number(s) : 1 N-4N , 1 S;-4r Date : Nov . 16 , 2002 Vi. Review' 'Summ,.. Land Use/Field : es : Micro-Irrigated Citrus Grove 158 Best Management Practices Applied For: Installation of Chemigation Infrastructure. Total BMPCosts: 70% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: .$ 31550 . 001 $2 , 485 20 124 . 25 $ 1 , 065 . 00 VII . 0em - w V IMM Od C6`nservatidni9t! .73W ignature) Dati: (Checked By) Date: Q . IRSWCD .Approval Date (Applicant Signature) 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 furnish 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 tribunal . IRSWCD Page 3 ( 10-26-01 )