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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 />Title: <br />Date: <br />personally, appeared before me this day of <br />20_ who subscribed and swore to the above instrument in my presence. <br />Notary Public Name: My commission expires: <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 />62 <br />