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Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : jAppl . #52 , Graves Brothers Company77 Address : P . O . Box 277 Wabasso , FI , 32970 Tract Number(s) . Field Number(s) : 11 Date . X963 D VI . Review Summary: Land Use/Field . Acres : Micro-Irrigated Citrus Grove 123 Best Management Practices Applied For. 1 . Installation of Micro-Irrigation System . Total BMP Costs : 31 .75% Cost Share Div By Total Eval Points: = Applicant's Score: Applicant Cost: $96 ,450 $302619 123 248. 93 $65 , 831 . 48 Revised :12/8/03 41 .560/oCost Share $96 , 450 $9 , 462 Vil. Remarks : This Review Sheet has been revised to reflect contract year end moneys not spent and offered to under - funded Cooperator. Cooperator has fully installed practice, and been paid the $30, 19 . Cooperator accepts this portion of unspent contract moneys added to original amount. V%1 . Designated Conservationist: (4014� 10 A10 (Signature) Date: (Checked By) te: LLC / 0,154" ' WCD Board Approval Date l Z - C7 o � (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 )