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r JUN 15 1983 <br />� �U 696 <br />P. <br />P_ <br />4. Certified compliance with Section 200.065, Florida Statutes, and if applicable, with Section <br />200.085, Florida ,Statutes as amended by Chapter 82-154, Laws of Florida. <br />5. CCr ifiea t,<<at perso.Ls ill its emjoy as police officers, as defined in Chapter 943, Florida <br />Statutes, meet the qualifications for employment as established by the i�oiice Siu.uuarUS <br />Council, that its salary plans meet the provisions of Chapter 943, Florida Statutes, and that <br />no police officer is compensated for his services at an annual rate of less than six thousand <br />dollars (6,000.00). <br />(A) Police Officers, as defined in Chapter 943, Florida Statutes, employed by this <br />Unit meet the qualifications for employment as established by the Police Stan- <br />dards Council. <br />Yes C No O <br />' (I3) The salary structure and salary plans for law enforcement officers meet the pro- <br />visions of Chapter 943, Florida Statutes. <br />Yes ❑ No ❑ <br />(C) All police officers, as defined in Chapter 943, Florida Statutes, are compensated <br />at an annual salary rate of six thousand dollars (6,000.00) or more. <br />Yes IN No ❑ <br />If the answer to (C) above is (NO), please state as an addendum to this appli- <br />cation any reason you may have for waiver of such requirement (one of which <br />must be that y u are lLiing ten n m' Is of ad valorem taxes). <br />SIGNED: DATE: <br />Appropriate Law Enforcement Officer <br />❑ 6. If you have no police department, etc., please check the block to the left side. <br />PART THREE <br />I hereby certify that all of the foregoing information is accurate and true to the best of my knowledge. I <br />further certify that I will promptly report to the Department of Revenue any change in the above.infor- <br />ination. I also realize that failure to provide timely information required, pursuant to the administration of <br />this Act shall, by such action, authorize the Department to utilize the best information available or, if no <br />such information is available, to take necessary action including DISQUALIFICATION, EITHER PARTIAL <br />OR ENTIRE, and shall further, by such action, waive any right to challenge the determination of the De- <br />partment as to its share, _if any, pursuant to the privilege of receiving shared revenues from the Revenue <br />Sharing Trust Funds. <br />Do you believe that you have complied with ALL eligibility acquirements as set forth above? <br />Yes 0 No ❑ <br />If the answer to the above question is (NO), please provide as an attachment to this form the amount of <br />revenue necessary to meet your obligations as a result of pledges or assignments or trusts entered into which <br />obligated funds received from revenue sharing. <br />SIGNED: SIGNED: - <br />Fi c Officer) (Mayor or Chairman of Governing Body) <br />DATE: I. I %`k.�DATE: � y I $'3 <br />MAIL COMPLETED ORIGINAL APPLICATION TO ADDRESS SHOWN BELOW <br />Delkartrnent of Revenue t Apprived t�'l form <br />Bureau of Finance and Accounting t and leg C ,f'tcizncy <br />Carlton Building, Room 143 <br />Tallahassee, Florida 32301 ` <br />ar Itv. . Brandenburg <br />b, Attorney <br />12 <br />