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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />APPLICANT SIGNATURE <br />Application is hereby made for the activities described herein. I certify that I am familiar with the information contained <br />in the application, and to the best of my knowledge and belief, this information is true, complete, and accurate. I <br />further certify that I possess the authority (see grant guidelines Section IV, 4.4) to sign on behalf of the Applicant and <br />that the Applicant has the ability to undertake the proposed activities in compliance with the FWC Derelict Vessel <br />Removal Grant Program Guidelines. <br />I also certify that the applicant's governing body is aware of and has authorized the project manager as the official <br />representative of the applicant to act in connection with this application and subsequent project, as well as to provide <br />additional information as may be required. By my signature below, the applicant agrees to comply with all applicable <br />federal, state, and local laws in conjunction with this proposal and the resulting project if approved. <br />Print/Type Name: <br />Signature: <br />STATE OF FLORIDA, COUNTY OF SELECT ONE <br />Susan Adams <br />.• "ro mM/s"•. <br />�•�'�y s����•:Title: <br />Date: <br />• Q. <br />., R COuN , <br />December 5, 2023 <br />personally, appeared before me this 5th day of December <br />2021 who subscribed and swore <br />to the <br />above instrument in my presence. � <br />Notary Public Name: .,l�.,�l(,J �, 1.L6+nU My commission expires:0q <br />—6q- Joa-7 <br />NOTE: Instruction and further information regarding this application and the FWC Derelict Vessel Removal Grant <br />Program can be found in the Program's Guidelines document or by contacting the Program Administrator at: Florida <br />Fish and Wildlife Conservation Commission, Boating and Waterways Section, Derelict Vessel Program, 620 South <br />Meridian Street, Tallahassee, FL 32399-1600 or call (850) 488-5600 <br />APPROVED AS TO FORM <br />AND LEGAL SUFFICIENCY <br />BY <br />WILLIAM W DE AL <br />COUN TY ATTORNEY <br />.... KIMBERLY K. MOIRANO <br />• * _. MY COMMISSION i HH 968126 <br />• 71 'JA EXPIRES: Aprl 0. 2027 <br />Attest: Ryan L. Butler, Clerk of <br />Circuit Court and Comptroller <br />/ ! / Imo! � <br />FWC/DV-APP (Feb 2020) 10 Rule 68-1.003 <br />