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P <br />OMB Approval No. 29-R0215 <br />a. NUMBER 3. STATE a. NUMBER <br />2. APPU• 2 APPLICA- - _ <br />FEDERAL ASSISTANCE CANT'S TION b. DATE Year ,wont. day <br />L <br />APPLI• b. DATE Year <br />TYPE E]PREAPPLICATION ear month day FIER ASSIGNED 19 <br />CATION <br />ACTION D APPL)CATION <br />yyWorkO (� NOTIFtCAT1ON OF INTENT (OPO Lease, <br />horoprIatez) REPORT OF FEDERAL ACTION <br />Blank, 5. FEDERAL EMPLOYERIDENTIFICAT{ON NO. <br />g. LEGAL APPLICANT/RECIPIENT <br />e. Applicant Name t Board of Co. Commissioners Indian Rive & p 4 - <br />b. Organization Unit : County °' NUMBERa. street/P.D. Dox Room 115 -County Courthouse PRO b. TME <br />t Vero Beach a. County t Indian River (From Water and Waste Disposal <br />d. City g, zip Code. 32960S stems for rural Com - <br />I. state °Florida FoatP °a) y <br />munities <br />h Contact Person (Noma. 304-56 C Wodtke, Jr. <br />7-8$47 g, IypE OF Ap UCANT/RECIPIENT <br />& telephone No.) p "late N -Community "on Agency CRIPTION OF APPLICANTS PROJECT "latrshta I- Higher Educational Institution <br />7, TITLE AND DES <br />Ci-SwbsmU J-IndiewTritra <br />D- O'lCounty y(-0ther (Speesfo: <br />u E-Clq <br />GG. SPW481 Purpose <br />Gifford Community Water and' Sewemd District <br />r Improvements District <br />Enter appropriate letter �] <br />9. TYPE OF ASSISTANCE <br />A-Saaw Grant . D -Insurance <br />B_%pplamsatei Grant E-0ther Enter appro- <br />C -Loan priate letter(a) <br />O <br />11. ESTIMATED NUM- 12. TYPE OF APPLICATION <br />C -Revision E-Augmentattsn <br />10. AREA OF PROJECT IMPACT lfaa`e-e�)a'trae•°°untsea' BER FI PERSONS A -New bastion <br />5 BENEFIT{NG �Rensanl D-tAn E.W apyropriate latter <br />Gifford 7,000 126) <br />14. CONGRESSIONAL DISTRICTS OF: 15. TYPE OF E er (pe if ); <br />p-InueasaDalIsn f -Other (Specify)r <br />13. PROPOSED FUNDING b. PROJECT B -Decease Oallars. <br />.00 a. APPLICANT 0-Incr"an Duration <br />a. FEDERAL s 1 195 000 D -Decrease IMrattoa <br />b. APPLICANT .00 1O - E• -Cancellation <br />I 16 PROJECT START 17. PROJECT Enter appro- <br />.00 DURATION priate Lette,r(a) <br />w STATE DATE <br />7a 9 13 lO Months <br />d. LOCAL 00 <br />,00 18' gigUBMI'fTEDATED 7Ta0 Year month dos 19. EXISTING FEDERAL IDENTIFlCATION NUMBE <br />e. OTHER 19 77 9 . - 13 N <br />0 00 FEDERAL AGENCY It 21. REMARKS ADDED <br />f. TOTAL $ + Ft. Pierce, FL 33450 <br />20.FEDERAL AGENCY TO RECEIVE REQUEST (Name, City, State, Zip node) 0 Yes No <br />Farmers Home Administration Pe er Tree Office Pa <br />tiwtion was submitted, Pursuant to in- No ree Response <br />b. If r wired by OMa Circular -9e thil cleari001-ti and all raspnnaaa ere attacl+ed: Spans <br />22, a. To the best of my krrowledga and belief, struettiiom therein, to opproP+ <br />t data In this lunaPPticetton/applieatied are ❑ ❑ <br />THE true and correct, the document has bean t^1 <br />APPLICANT duty authorized by the governing body of (1) U ❑ <br />CERTIFIES the applicant and the spPlian! will camptyif the assist (2) ❑ ❑ <br />g THAT P� with the attached eswrances <br />ansa is aPPmvsd. (3) t DAT£ SIGNED <br />a StCNATURE Year month day <br />°. TYPED NAME AND TITLE 19 <br />CERTIFYING (� 2�11h , 77 9 13 <br />�a REPRE• �'. _ Ih..t 11 .i L <br />TENTATIVE William G. Wodtke, Jr. y5, pppucA• Year month nay <br />TION <br />24. AGENCY NAME RECEIVED 19 <br />27, ADMINISTRATIVE OFFICE <br />2L FOEN7 F AP ON ATION <br />2& ORGANIZATIONAL UNIT - <br />_ 30. FEDERAL <br />o pEIGRANT <br />NTFlCA I <br />Fos 29. ADDRESS <br />Year month day 34. Year month day <br />x 32 FUNDING STARTING <br />31. ACTION TAKEN 19 DATE 19 <br />a. FEDERAL $ .00 33. ACTION )ATE A <br />0 a. AWARDED OD 35. CONTACT FOR ADDITIONAL FORMA• 3fw Year month day <br />0 b. REIECTED b. APPLICANT TION (Name and telephone ENDING <br />.00 DATE 19 <br />0 u RETURNED FOR c. STATE 37. REMARKS ADDED <br />.00 <br />C AMENDMENT d. LOCAL •� <br />❑ <br />o (] d. DEFERRED e. OTHER Yes nNo <br />.00 <br />W e. WITHDRAWN I I. TOTAL tas were con. b. FEDERAL AGENCY A-95 OFFICIAL <br />35+ stdared. If adeacY respontstoas of Pert 1, OMB Cueulu A-95, Name telephone no.) <br />se is due under Prm <br />FEDERAL AGENCY it has been or is being made. <br />A-95 ACTION _ STANDARD FORM 424 PAGE 1 (10-75) <br />j lPreatrl6ed by GSA. FSdaral hlanaDament Circular 74-7 <br />t <br />� e <br />SEP 13197 <br />ikoox 3.1 PA. ;r 91 <br />