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APPLICANT SIGNATURE <br />STATE CF FLORIDA <br />WDWN RWER COUNTY <br />THIS ISTO CERTIFY THAT THIS IS ATRUE AND CORRECT <br />COPY OC THE ORIGMAL ONFILE W THIS OFFICE. <br />RYAN Ir '1 a�-,}(L <br />BY _, D.C. <br />Application is hereby made for the activities described herein. I certify that I dMirfaMiliar Viith theinformation 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 />INDIAN RIVER <br />y�oniMis, .. ,. <br />-isle: <br />Chairman <br />May 22, 2024 <br />Susan Adams personally, appeared before me this 22nd day of Ma <br />20 24 who subscribed and swore to the above instrument in my presence. <br />Notary Public Name: _ ► —t D C-t� My commission expires: 04/09/2027 <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 />:; i " KIMBERLY K. MOIM W <br />+� *:= MY COMMISSIONS HH 368126 <br />EXPIRES: Apd 9, 2027 <br />Attest: Ryan L. Butler, Clerk of <br />Circyi Court and Comptroller <br />i( <br />Deputy Clerk <br />APPROVED AS TO FORM <br />ANVILLIAM <br />AL SLI tC Y <br />BY <br />K. E RAAL <br />COUNTY ATTORNEY <br />FWC/DV-APP (Feb 2020) 5 Rule 68-1.003 <br />