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r � t Cont' d from pg 2 . Application Evaluation Review Sheet Y Y• Applicant Name : Appl . #52, Graves Brothers Company Address : P . O . Box 277 Wabasso , FI . 32970 Tract Number(s) : Field Number(s ) : 1 Date : 1 /1312003 VI. Review Summa Land Use/Field : Acres . Micro41rri ated Citrus Grove 123 Best Management Practices Applied For. 1 . Installation of Micro4iiijatlon system . Total BMP Costs : A31 .75% Co are Div By Total Eval Points: = Applicant's Score: Applicant Cost: $96 ,450. $30 ,619 123 248 . 93 $659831 . VII. Remarks. No EQIP funding VIIL Designated Con ationist: I / 3 63 (Signature) (Checked By) Date: ft -/.3 - �3 IRSWCD Board 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 . 590a4 (Sal and Water Conversation) ; 16U .S .C . 3801 at seq . (Food Security Ado 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 tribunal. IRSWCD Page 3 ( 10-26-01 )