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JUN BOOK 61 rAGt-1 (B) The salary structure and salary plans for law enforcement officers meet the pro- visions of Chapter 943, Florida Statutes. Yes & No ❑ (C) All police officers, as defined in Chapter 943, Florida Statutes, are compensated at an annual salary rate of six thousand dollar; (6,000.00) or more. Yes qi No ❑ If the answer to (C) above is (NO), please state as an -addendum to this appli- cation pplication any reason you may have for waiver of such requirement (one of which must be that you are levying ten (10 mills of ad valorem taxes). u w SIGNED: DATE:s Appropriate Law Enforcement Officer R. T. "Tun" Dobeck. ❑ 6. If you have no police department, etc., please check the block to the left side. 7. Certified that persons in its employ as firefighters, as defined in Section 633.30(1), Florida Statutes, meet the qualification for employment as established by the Division of State Fire Marshal pursuant to the provisions of Sections 633.34 and 633.35, Florida Statutes, and that the provisions of Section 633.382 are met. (A) Does the addressed unft of government employ any fulltime firefighters which currently possess either a B.A. or A.A. (college) degree in a fire -related subject, provided that degree is not required for their current position? Yes 6 No ❑ (B) If so, are these firefighters currently receiving supplemental compensation for those degrees? Yes No ❑ Does not Apply ❑ SIGNE b DATE:s 23—� Appropriate Fire fficial Forrest R. Smith ❑ 8. If you have no fire department or a strictly volunteer fire department, etc., please check block to the left side. PART THREE I hereby certify that all of the foregoing information is accurate and true to the best of my knowledge. I further certify that I will promptly report to the Department of Revenue any change in the above infor- mation. I also realize that failure to provide timely information required, pursuant to the administration of this Act shall, by such action, authorize the Department to utilize the best information available or, if no such information is available, to take necessary action including DISQUALIFICATION, EITHER PARTIAL OR ENTIRE, and shall further, by such action, waive any right to challenge the determination of the De- partment as to its share, if any, pursuant to the privilege of receiving shared revenues from the Revenue Sharing Trust Funds. Do you believe that you have complied with ALL eligibility requirements as set forth above? Yes 6 No ❑ If the answer to the above question is (NO), please provide as an atnt to this form the amount of revenue necessary to meet your obligations as a result of pledges or i ents or trusts entered into which obligated funds received from revenue shharri_n� SIGNED: K ^� ' SIGNE - e&is 1 Officer) (Mayor or Chairma o Governing Body) OFR Y BARTON o PATRICK B. LYONS DATE: _ S �a3 V 65 DATE: Jimt, Sy 1()R-; MAIL COMPLETED ORIGINAL APPLICATION TO ADDRESS SHOWN BELOW Department of Revenue Bureau of Finance and Accounting Carlton Building, Room 143 Tallahassee. Florida 32301 18