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M M <br />ELIGIBILITY APPLICATION FOR PUBLIC AGENCIES <br />FEDERAL SURPLUS PROPERTY UTILIZATION PROGRAM <br />Legal Name of Applicant Indian River County Civil_ Defense <br />Address Avenuge. Vero Beach Florida <br />County Indian River Area code 305 <br />Date Agency began Operation Prior to 1965_ <br />1. Check type of Agency: (See definitions onreverse side) <br />a. <br />Conservation ---- <br />f. <br />State Agency ---- <br />b. <br />Economic Development ---- <br />g. <br />County Govt. ---- <br />c. <br />Parks & Recreation <br />h. <br />City Government ---- <br />d. <br />_ <br />Public Safety <br />i. <br />Indian tribe, group, band, <br />e. <br />Museum ---- <br />Pueblo (State Reser- <br />vation only) ---- <br />J. <br />Other ---- <br />2. Attach a narrative which describes the program and services offered. <br />Also attach evidence that the applicant is a public agency. <br />3. How is the activity funded: (Show percentages) <br />a. Tax -supported (other than by grant) 100% <br />b. By grant and/or contributions <br />c. Other (specify) <br />4. Attach completed Assurance of Compliance with GSA Regulations under <br />Title VI of the Civil Rights Act of 1964, Section 606 of Title VI <br />of the Federal Property and Administrative Services Act of 1949, <br />as amended, and Section 504 of the Rehabilitation Act of 1973, <br />as amended. <br />t <br />5. Attach an Authorization Document completed by the Governing Board <br />or Body designating one or more representatives to act -for the <br />applicant acquiring property from the State Agency, to commit the <br />expenditure of funds, and to execute the State Agency's invoice/ <br />issue sheet, including Terms, Conditions, Reservations, and Re- <br />strictions that the State Agency or GSA may -establish on the <br />property. <br />t - <br />SIGNATURE: G <br />ATE: December 15. 1882 Please print nameon this line: Don C. Scurlock, J . <br />s <br />TITLE: Chairman, Board of Coami.ssioners <br />Indian River County <br />FOR STATE AGENCY USE <br />Date Approved: Date Disapproved: <br />Conditional Eligibility Director: <br />23-A <br />Z mt- e3 0 <br />