2024-110 - Laserfiche WebLink

Home Browse Search

APPLICANT SIGNATURE Application is hereby made for the activities described herein. I certify that I am familiar with the information contained in the application, and to the best of my knowledge and belief, this information is true, complete, and accurate. I further certify that I possess the authority (see grant guidelines Section IV, 4.4) to sign on behalf of the Applicant and that the Applicant has the ability to undertake the proposed activities in compliance with the FWC Derelict Vessel Removal Grant Program Guidelines. I also certify that the applicant's governing body is aware of and has authorized the project manager as the official representative of the applicant to act in connection with this application and subsequent project, as well as to provide additional information as may be required. By my signature below, the applicant agrees to comply with all applicable federal, state, and local laws in conjunction with this proposal and the resulting project if approved. Print/Type C Signature: STATE OF FLORIDA, COUNTY OF SELECT ONE INDIAN RIVER Chairman May 22, 2024 Susan Adams personally, appeared before me this 22nd day of May 20 24 who subscribed and swore to the above instrument in my presence. Notary Public Name: ��,r(�4 %t'f p �,t�p� My commission expires: 04/09/2027 NOTE: Instruction and further information regarding this application and the FWC Derelict Vessel Removal Grant Program can be found in the Program's Guidelines document or by contacting the Program Administrator at: Florida Fish and Wildlife Conservation Commission, Boating and Waterways Section, Derelict Vessel Program, 620 South Meridian Street, Tallahassee, FL 32399-1600 or call (850) 488-5600 Attest Ryan L. Butler, Clerk of Cirqut,Court and Cw"allor Dw* Cleric FWC/DV-APP (Feb 2020) (`*Prolv) ��yI WAMYK.N01111 O�M111 �#HHNW126.OMMAppf 9.2027 APPROVED AS TO FORM AND LEG L SUORAAVL BY LLlAM K. E COUNTY ATTORNEY Rule 68-1.003 FWC/DV-APP (Feb 2020) 27 Rule 68-1.003